Healthcare Provider Details

I. General information

NPI: 1215494232
Provider Name (Legal Business Name): ANNELISE DENNING RDH, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CLEVELAND AVE SE
OLYMPIA WA
98501-7718
US

IV. Provider business mailing address

115 CLEVELAND AVE SE
OLYMPIA WA
98501-7718
US

V. Phone/Fax

Practice location:
  • Phone: 707-732-4494
  • Fax: 360-352-2784
Mailing address:
  • Phone: 707-732-4494
  • Fax: 360-352-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00005961
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61632689
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: