Provider Demographics
NPI:1831342997
Name:FLESCH, MATTHEW PERRINE (LAC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PERRINE
Last Name:FLESCH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6513
Mailing Address - Country:US
Mailing Address - Phone:425-218-3094
Mailing Address - Fax:425-402-8489
Practice Address - Street 1:318 2ND ST S
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6513
Practice Address - Country:US
Practice Address - Phone:425-218-3094
Practice Address - Fax:425-402-8489
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60036535171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist