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General NPI Number Information
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NPI Number | 1497321186
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Entity Type | Organization
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Legal Business Name | HEART'S DESIRE CRANIOSACRAL AND MASSAGE THERAPY
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Dates
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Enumeration Date | 06/02/2021
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 504 WASHINGTON ST STE 5
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City | VANCOUVER
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State | WA
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Zip | 98660-3138
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Country | US
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Telephone | 360-524-2772
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65595
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City | VANCOUVER
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State | WA
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Zip | 98665-0020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LMT
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Name | AMY WYENBERG
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Credential |
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Telephone | 360-524-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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