Provider Demographics
NPI:1730388547
Name:HENDRICKS, ALISA M (LMP)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:M
Last Name:HENDRICKS
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 1:3719 168TH ST NE
Mailing Address - Street 2:UNIT C
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8499
Mailing Address - Country:US
Mailing Address - Phone:425-501-6545
Mailing Address - Fax:
Practice Address - Street 1:3719 168TH ST NE
Practice Address - Street 2:UNIT C
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8499
Practice Address - Country:US
Practice Address - Phone:425-501-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist