Provider Demographics
NPI:1801295274
Name:SACKETT, SIENNA LYNN MARIE (MT)
Entity type:Individual
Prefix:
First Name:SIENNA
Middle Name:LYNN MARIE
Last Name:SACKETT
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 NE 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-7319
Mailing Address - Country:US
Mailing Address - Phone:360-991-8515
Mailing Address - Fax:
Practice Address - Street 1:3000 SE 164TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9314
Practice Address - Country:US
Practice Address - Phone:360-896-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist