Healthcare Provider Details

I. General information

NPI: 1508532532
Provider Name (Legal Business Name): ELIZABETH MARIE LANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5726
US

IV. Provider business mailing address

13925 INTERURBAN AVE S STE 120
TUKWILA WA
98168-5726
US

V. Phone/Fax

Practice location:
  • Phone: 206-948-0096
  • Fax:
Mailing address:
  • Phone: 206-948-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: