Provider Demographics
NPI:1982580122
Name:PARKS, VANESSA LEA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:LEA
Last Name:PARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 ALABAMA ST APT 204
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4572
Mailing Address - Country:US
Mailing Address - Phone:360-325-1589
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD FAIRHAVEN PKWY STE 203
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7446
Practice Address - Country:US
Practice Address - Phone:360-325-1589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA70017528225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist