Healthcare Provider Details

I. General information

NPI: 1760516132
Provider Name (Legal Business Name): JODY MARIE BICKLE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODY MARIE LAPPIER LMT

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 1ST AVE NE
DUVALL WA
98019
US

IV. Provider business mailing address

24121 NE 140TH ST
WOODINVILLE WA
98077
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 253-232-6377
  • Fax: 425-788-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00010003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: