Provider Demographics
NPI:1649033549
Name:MARIEN, COLETTE ALYSE (LAC, EAMP)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:ALYSE
Last Name:MARIEN
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HARVARD AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3836
Mailing Address - Country:US
Mailing Address - Phone:773-490-7012
Mailing Address - Fax:
Practice Address - Street 1:1515 1ST AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1523
Practice Address - Country:US
Practice Address - Phone:206-903-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61507890171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1659883247OtherGROUP NPI