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General NPI Number Information
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NPI Number | 1114738671
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Entity Type | Individual
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Provider Name | ADELYN RE'ANN MALETZKE LMT
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 202 W 1ST ST
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City | CLE ELUM
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State | WA
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Zip | 98922-1154
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Country | US
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Telephone | 509-674-5057
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Fax | 509-674-6946
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Provider Business Mailing Address
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Address Line | 830 LOPING LN
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City | CLE ELUM
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State | WA
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Zip | 98922-9531
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Country | US
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Telephone | 509-856-7371
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA61614248
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License Number State | WA
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