Healthcare Provider Details

I. General information

NPI: 1013330604
Provider Name (Legal Business Name): SHANNON LOU MORTON LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2014
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27641 COVINGTON WAY SE STE 1
COVINGTON WA
98042-9120
US

IV. Provider business mailing address

20007 RHODODENDRON DR E
BONNEY LAKE WA
98391-7799
US

V. Phone/Fax

Practice location:
  • Phone: 253-880-7827
  • Fax:
Mailing address:
  • Phone: 253-880-7827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60444054
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: