Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60690667 | WA |
NPI | 1003323197 |
---|---|
Provider Name | Elisabeth Grace Hacking |
First Address | Snohomish, WA 98296-8088 |
Second Address | Kirkland, WA 98034-4175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2018 |
Last Update Date | 10/01/2018 |