Provider Demographics
NPI:1548478753
Name:ECKEL, COLLEEN MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:ECKEL
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 1:8116 NE 143RD ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-0707
Mailing Address - Country:US
Mailing Address - Phone:206-962-1906
Mailing Address - Fax:
Practice Address - Street 1:2207 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7097
Practice Address - Country:US
Practice Address - Phone:206-962-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225700000X225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist