Provider Demographics
NPI:1437975000
Name:BIBEAU, ANDREA L (LAC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:BIBEAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4032
Mailing Address - Country:US
Mailing Address - Phone:206-388-8711
Mailing Address - Fax:
Practice Address - Street 1:1406 E PINE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4032
Practice Address - Country:US
Practice Address - Phone:206-388-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61619341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist