Healthcare Provider Details

I. General information

NPI: 1053222679
Provider Name (Legal Business Name): ANASTASIIA VASYLENKO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 NE 94TH AVE UNIT B
VANCOUVER WA
98662-4408
US

IV. Provider business mailing address

6606 NE 94TH AVE # B
VANCOUVER WA
98662-4408
US

V. Phone/Fax

Practice location:
  • Phone: 564-203-8277
  • Fax:
Mailing address:
  • Phone: 564-203-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA.70155951
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: