Provider Demographics
NPI:1447856984
Name:ISAACSON, ASHLEY ELLIS (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELLIS
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:JORDAN
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:300 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3214
Mailing Address - Country:US
Mailing Address - Phone:360-831-3834
Mailing Address - Fax:360-553-4165
Practice Address - Street 1:300 E 24TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3214
Practice Address - Country:US
Practice Address - Phone:360-831-3834
Practice Address - Fax:360-553-4165
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61043224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist