Provider Demographics
NPI:1619362886
Name:THELIN-KNOX, VANESSA (LAC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:THELIN-KNOX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3488
Mailing Address - Country:US
Mailing Address - Phone:301-204-6470
Mailing Address - Fax:
Practice Address - Street 1:7142 CARROLL AVE APT 3
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4673
Practice Address - Country:US
Practice Address - Phone:240-750-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02187171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist