Healthcare Provider Details

I. General information

NPI: 1780965681
Provider Name (Legal Business Name): KAMMI LYNN MADSEN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 148TH AVE NE
REDMOND WA
98052-5527
US

IV. Provider business mailing address

1203 JAMES ST APT 203
SEATTLE WA
98104-2105
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-5808
  • Fax: 425-283-5022
Mailing address:
  • Phone: 509-263-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60136712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: