MEDICARE: DEEDEE MARIE VANCLEEF L.M.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA00008446	WA

General Provider Information

NPI Number	:	1902940885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEDEE MARIE VANCLEEF L.M.P.

Provider Business Mailing Address
First Line	:	13611 N MINIHDOKA TRL
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-5066
Country	:	US
Telephone Number	:	509-464-1153
Fax Number	:	509-466-1216

Provider Business Practice Location Address
First Line	:	624 W HASTINGS RD STE 11
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2877
Country	:	US
Telephone Number	:	509-464-1153
Fax Number	:	509-466-1216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	10/13/2015

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