Healthcare Provider Details

I. General information

NPI: 1548438658
Provider Name (Legal Business Name): EMMA DEERHEART KINGSTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA KRISTIN LEDBETTER LMT

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SW CASCADE AVE # 40F
STEVENSON WA
98648-6284
US

IV. Provider business mailing address

262 CEDAR CREEK RD
CARSON WA
98610-3112
US

V. Phone/Fax

Practice location:
  • Phone: 509-416-6191
  • Fax:
Mailing address:
  • Phone: 509-416-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61311890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: