Provider Demographics
NPI:1962758276
Name:KENNEDY, ALISON COLLEEN (LMP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:COLLEEN
Last Name:KENNEDY
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 1:3902 SW SOUTHERN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2342
Mailing Address - Country:US
Mailing Address - Phone:206-923-8766
Mailing Address - Fax:
Practice Address - Street 1:6017 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1612
Practice Address - Country:US
Practice Address - Phone:206-923-8766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60270885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist