Healthcare Provider Details

I. General information

NPI: 1588571665
Provider Name (Legal Business Name): MOUNTAIN MEADOWS ELECTROLYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 NE 94TH AVE STE D
VANCOUVER WA
98662-6180
US

IV. Provider business mailing address

32606 NE PARCEL AVE
YACOLT WA
98675-3803
US

V. Phone/Fax

Practice location:
  • Phone: 360-601-0621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name: LEAH EILEEN LAFAVOR
Title or Position: OWNER
Credential:
Phone: 360-601-0621