Provider Demographics
NPI:1902940885
Name:VANCLEEF, DEEDEE MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:DEEDEE
Middle Name:MARIE
Last Name:VANCLEEF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:MARIE
Other - Last Name:VAN CLEEF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13611 N MINIHDOKA TRL
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5066
Mailing Address - Country:US
Mailing Address - Phone:509-464-1153
Mailing Address - Fax:509-466-1216
Practice Address - Street 1:624 W HASTINGS RD STE 11
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2877
Practice Address - Country:US
Practice Address - Phone:509-464-1153
Practice Address - Fax:509-466-1216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist