Provider Demographics
NPI:1306483664
Name:SIEVERTSON, AIDAN (LMT)
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:
Last Name:SIEVERTSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 NE LITTLE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8677
Mailing Address - Country:US
Mailing Address - Phone:206-861-5323
Mailing Address - Fax:
Practice Address - Street 1:931 HILDEBRAND LN NE STE 101
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2823
Practice Address - Country:US
Practice Address - Phone:206-842-2690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60984186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist