Provider Demographics
NPI:1457421232
Name:GROOTHUIZEN, DENISE RENEE (MSLAC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:GROOTHUIZEN
Suffix:
Gender:F
Credentials:MSLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3819
Mailing Address - Country:US
Mailing Address - Phone:206-948-9810
Mailing Address - Fax:206-709-2271
Practice Address - Street 1:900 E SHELBY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3819
Practice Address - Country:US
Practice Address - Phone:206-948-9810
Practice Address - Fax:206-709-2271
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC000000720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist