Provider Demographics
NPI:1700524931
Name:BLANKENSHIP, HALEY LUCIDO (LMT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LUCIDO
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:MICHELE
Other - Last Name:LUCIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2220 SE 192ND AVE APT B404
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1444
Mailing Address - Country:US
Mailing Address - Phone:334-235-1981
Mailing Address - Fax:
Practice Address - Street 1:104 GRAND BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7707
Practice Address - Country:US
Practice Address - Phone:360-695-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61295633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist