Provider Demographics
NPI:1780890558
Name:WOYCKE, ELYCE TAJIMA (LAC)
Entity type:Individual
Prefix:
First Name:ELYCE
Middle Name:TAJIMA
Last Name:WOYCKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ELYCE
Other - Middle Name:
Other - Last Name:TAJIMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:6311 46TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1432
Mailing Address - Country:US
Mailing Address - Phone:206-933-0909
Mailing Address - Fax:
Practice Address - Street 1:6311 46TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1432
Practice Address - Country:US
Practice Address - Phone:206-933-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602-586-650171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA56-2615783OtherEIN NUMBER