Provider Demographics
NPI:1851451165
Name:BOOTH, ANDREA J (MA AC LIC AC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MA AC LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2401 8TH AVE N #101
Mailing Address - Street 2:4500 9TH AVE NE SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:206-369-2156
Mailing Address - Fax:206-829-2409
Practice Address - Street 1:4500 8TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-829-2408
Practice Address - Fax:206-829-2409
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist