Provider Demographics
NPI:1588914998
Name:BUSKENESS, KALIE ELLEN (LMP)
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:ELLEN
Last Name:BUSKENESS
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 1:510 E WOODIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-9148
Mailing Address - Country:US
Mailing Address - Phone:425-418-6879
Mailing Address - Fax:509-888-1058
Practice Address - Street 1:510 E WOODIN AVE
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-9148
Practice Address - Country:US
Practice Address - Phone:425-418-6879
Practice Address - Fax:509-888-1058
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist