Provider Demographics
NPI:1871847442
Name:WOLFANG, MELISSA H (LMP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:H
Last Name:WOLFANG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:HEATHER
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:21009 76TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7126
Mailing Address - Country:US
Mailing Address - Phone:425-672-2910
Mailing Address - Fax:425-778-1872
Practice Address - Street 1:21009 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7126
Practice Address - Country:US
Practice Address - Phone:425-672-2910
Practice Address - Fax:425-778-1872
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60149895225700000X
WAMA60149895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist