Healthcare Provider Details

I. General information

NPI: 1760517916
Provider Name (Legal Business Name): ROXANE GELLER LAC, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 15TH AVE E STE 304
SEATTLE WA
98112-5156
US

IV. Provider business mailing address

340 15TH AVE E STE 304
SEATTLE WA
98112-5156
US

V. Phone/Fax

Practice location:
  • Phone: 206-409-0566
  • Fax: 206-709-9657
Mailing address:
  • Phone: 206-409-0566
  • Fax: 206-709-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1869
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10361
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13623
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: