Healthcare Provider Details

I. General information

NPI: 1548795594
Provider Name (Legal Business Name): LICE CLINICS OF AMERICA BELLEVUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 156TH AVE NE STE L
BELLEVUE WA
98007-4421
US

IV. Provider business mailing address

1504 184TH AVE NE
BELLEVUE WA
98008-3303
US

V. Phone/Fax

Practice location:
  • Phone: 206-719-2644
  • Fax:
Mailing address:
  • Phone: 206-719-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: TRACI LEIGH BENSON
Title or Position: OWNER
Credential:
Phone: 206-719-2644