Provider Demographics
NPI:1649669854
Name:INGALLS, REBEKAH W (EAMP, LMP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:W
Last Name:INGALLS
Suffix:
Gender:F
Credentials:EAMP, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 30TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2959
Mailing Address - Country:US
Mailing Address - Phone:206-789-0456
Mailing Address - Fax:
Practice Address - Street 1:3417 EVANSTON AVE N STE 408
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8969
Practice Address - Country:US
Practice Address - Phone:206-789-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002027171100000X
WAMA00011627225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist