Provider Demographics
NPI:1194533786
Name:CAMERON, VANESSA (LAC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2765 SUN VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-9118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 ANTHES AVE STE 201
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-5100
Practice Address - Country:US
Practice Address - Phone:512-934-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61425022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist