Provider Demographics
NPI:1538204839
Name:KLOBA, SHELLEY A (LMP)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:A
Last Name:KLOBA
Suffix:
Gender:F
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:THE DONALDSON CLINIC
Mailing Address - Street 2:16030 BOTHELL-EVERETT HWY. STE 200
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1741
Mailing Address - Country:US
Mailing Address - Phone:425-745-4910
Mailing Address - Fax:425-338-5709
Practice Address - Street 1:THE DONALDSON CLINIC
Practice Address - Street 2:16030 BOTHELL-EVERETT HWY. STE 200
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1741
Practice Address - Country:US
Practice Address - Phone:425-745-4910
Practice Address - Fax:425-338-5709
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3382SHOtherREGENCE
WA0159787OtherDEPT. OF L&I