Provider Demographics
NPI:1508730433
Name:SLACK, DAWN ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ELIZABETH
Last Name:SLACK
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 1:22225 E LOST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6820
Mailing Address - Country:US
Mailing Address - Phone:617-666-1265
Mailing Address - Fax:
Practice Address - Street 1:202 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1819
Practice Address - Country:US
Practice Address - Phone:425-780-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMT3893225700000X
WAMA61229933225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist