Provider Demographics
NPI:1306128640
Name:LYASHCHINA, YELENA
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:LYASHCHINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SE 139TH AVE
Mailing Address - Street 2:267
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3576
Mailing Address - Country:US
Mailing Address - Phone:360-600-1417
Mailing Address - Fax:
Practice Address - Street 1:237 NE CHKALOV DR
Practice Address - Street 2:120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5054
Practice Address - Country:US
Practice Address - Phone:360-828-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60133684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist