Provider Demographics
NPI:1811290372
Name:LANDBLOOM, ASHLEY RENEE (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RENEE
Last Name:LANDBLOOM
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
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Mailing Address - Street 1:3876 BRIDGE WAY N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7951
Mailing Address - Country:US
Mailing Address - Phone:206-624-6677
Mailing Address - Fax:206-525-5933
Practice Address - Street 1:3876 BRIDGE WAY N
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7951
Practice Address - Country:US
Practice Address - Phone:206-624-6677
Practice Address - Fax:206-525-5933
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WANT60186069175F00000X
WAAC60202398171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist