Provider Demographics
NPI:1902059603
Name:WEST, JOAN M (LMT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:WEST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BICKFORD AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1773
Mailing Address - Country:US
Mailing Address - Phone:425-238-7767
Mailing Address - Fax:
Practice Address - Street 1:1800 BICKFORD AVE STE 201
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-9904
Practice Address - Country:US
Practice Address - Phone:360-563-0629
Practice Address - Fax:360-563-0693
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0024643225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist