Provider Demographics
NPI:1861769366
Name:BROOKE K. DANIELSON, LMP
Entity type:Organization
Organization Name:BROOKE K. DANIELSON, LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:360-907-5144
Mailing Address - Street 1:615 SE CHKALOV DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5279
Mailing Address - Country:US
Mailing Address - Phone:360-885-1767
Mailing Address - Fax:360-885-1394
Practice Address - Street 1:615 SE CHKALOV DR
Practice Address - Street 2:SUITE 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-5279
Practice Address - Country:US
Practice Address - Phone:360-885-1767
Practice Address - Fax:360-885-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty