Provider Demographics
NPI:1457918351
Name:SYVERSON, BARBARA IRENE (LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:IRENE
Last Name:SYVERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NE 52ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1983
Mailing Address - Country:US
Mailing Address - Phone:503-522-2628
Mailing Address - Fax:
Practice Address - Street 1:418 NE 4TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2158
Practice Address - Country:US
Practice Address - Phone:503-522-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60961113174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty