Provider Demographics
NPI:1912036971
Name:VANEK, CYNTHIA GAIL (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:GAIL
Last Name:VANEK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NE PIERCE DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6535
Mailing Address - Country:US
Mailing Address - Phone:360-885-1950
Mailing Address - Fax:360-828-5814
Practice Address - Street 1:2700 NE ANDRESEN RD
Practice Address - Street 2:SUITE D11
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7347
Practice Address - Country:US
Practice Address - Phone:360-910-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist