Healthcare Provider Details

I. General information

NPI: 1568685642
Provider Name (Legal Business Name): ALEXANDRA O SOLLEK LMP, LAC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 WARREN AVE N
SEATTLE WA
98109-4027
US

IV. Provider business mailing address

2808 HARRIS PL S
SEATTLE WA
98144-5924
US

V. Phone/Fax

Practice location:
  • Phone: 206-291-2810
  • Fax: 206-400-7911
Mailing address:
  • Phone: 206-291-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6006789
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00017680
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: