Provider Demographics
NPI:1861387060
Name:HENRIKSON, SHANNON MARIE (LMT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:HENRIKSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 N CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1416
Mailing Address - Country:US
Mailing Address - Phone:509-771-1116
Mailing Address - Fax:
Practice Address - Street 1:208 S DIVISION ST # B
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1954
Practice Address - Country:US
Practice Address - Phone:509-771-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61374918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist