Provider Demographics
NPI:1144863820
Name:KESSEN, LAURIE LYNN BEATRICE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNN BEATRICE
Last Name:KESSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8148 STEIN RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98240-9407
Mailing Address - Country:US
Mailing Address - Phone:360-201-6737
Mailing Address - Fax:
Practice Address - Street 1:5709 HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9210
Practice Address - Country:US
Practice Address - Phone:360-201-6737
Practice Address - Fax:360-384-0350
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60995010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist