Healthcare Provider Details

I. General information

NPI: 1003179862
Provider Name (Legal Business Name): LISA SIGRID COLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20110 VASHON HIGHWAY SW
VASHON WA
98070
US

IV. Provider business mailing address

1901 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-4801
US

V. Phone/Fax

Practice location:
  • Phone: 206-234-3649
  • Fax:
Mailing address:
  • Phone: 206-322-7676
  • 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: