Provider Demographics
NPI:1386961282
Name:MCLEAN, VICTORIA LEANNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEANNE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEANNE
Other - Last Name:BRILZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:210 E MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3369
Mailing Address - Country:US
Mailing Address - Phone:360-693-3400
Mailing Address - Fax:
Practice Address - Street 1:210 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3369
Practice Address - Country:US
Practice Address - Phone:360-693-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-01
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60145354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist