Provider Demographics
NPI:1740312073
Name:SALESKY, AMBER LYNE (LMP)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNE
Last Name:SALESKY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:AMBER
Other - Middle Name:LYNE
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-1619
Mailing Address - Country:US
Mailing Address - Phone:509-447-2413
Mailing Address - Fax:
Practice Address - Street 1:601 HWY 20
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156
Practice Address - Country:US
Practice Address - Phone:509-447-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016563225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist