Provider Demographics
NPI:1184049942
Name:HESS, COREY (LMP)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HESS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 SUZANNE CT
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8609
Mailing Address - Country:US
Mailing Address - Phone:952-657-6055
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST
Practice Address - Street 2:204B
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9228
Practice Address - Country:US
Practice Address - Phone:952-657-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60249654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist