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General NPI Number Information
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NPI Number | 1316134711
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Entity Type | Individual
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Provider Name | LINDSAY JEAN RAVENSONG LMP
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Gender | Female
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 5214 DELRIDGE WAY SW #105
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City | SEATTLE
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State | WA
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Zip | 98106-1376
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Country | US
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Telephone | 206-295-3974
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Fax |
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Provider Business Mailing Address
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Address Line | 8627 12TH AVE SW #105
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City | SEATTLE
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State | WA
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Zip | 98106-2405
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Country | US
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Telephone | 206-295-3974
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00023926
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License Number State | WA
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