Provider Demographics
NPI:1932387701
Name:MACKIE, LAURA SYLVIA (LMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SYLVIA
Last Name:MACKIE
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 1:5898 N FORK RD
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:WA
Mailing Address - Zip Code:98244-9518
Mailing Address - Country:US
Mailing Address - Phone:360-820-4060
Mailing Address - Fax:
Practice Address - Street 1:8251 KENDALL RD.
Practice Address - Street 2:
Practice Address - City:MAPLE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98266
Practice Address - Country:US
Practice Address - Phone:360-820-4060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60240324225700000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator