Provider Demographics
NPI:1831333681
Name:PASSIC, EMILY JEAN (ND)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:PASSIC
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12815 120TH AVE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3003
Mailing Address - Country:US
Mailing Address - Phone:425-898-4732
Mailing Address - Fax:425-298-0434
Practice Address - Street 1:12815 120TH AVE NE
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3003
Practice Address - Country:US
Practice Address - Phone:425-898-4732
Practice Address - Fax:425-298-0434
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WANT60713022175F00000X
WAMA00024911225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist