Provider Demographics
NPI:1174786495
Name:LEE, VANESSA (LMP)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19916 OLD OWEN RD
Mailing Address - Street 2:#414
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9778
Mailing Address - Country:US
Mailing Address - Phone:425-802-6579
Mailing Address - Fax:
Practice Address - Street 1:118 N LEWIS ST
Practice Address - Street 2:SUITE 114
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1516
Practice Address - Country:US
Practice Address - Phone:425-802-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60021401225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist