Provider Demographics
NPI:1316134711
Name:RAVENSONG, LINDSAY JEAN (LMP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JEAN
Last Name:RAVENSONG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 12TH AVE SW
Mailing Address - Street 2:#105
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2405
Mailing Address - Country:US
Mailing Address - Phone:206-295-3974
Mailing Address - Fax:
Practice Address - Street 1:5214 DELRIDGE WAY SW
Practice Address - Street 2:#105
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1376
Practice Address - Country:US
Practice Address - Phone:206-295-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist