Provider Demographics
NPI:1962543561
Name:LANEY, KIM (LAC LMP CSP)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:LANEY
Suffix:
Gender:F
Credentials:LAC LMP CSP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:LANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21106 49TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7712
Mailing Address - Country:US
Mailing Address - Phone:206-920-7436
Mailing Address - Fax:
Practice Address - Street 1:6722 200TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5932
Practice Address - Country:US
Practice Address - Phone:206-920-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA8997171W00000X
WAAC61065036171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty