Individual
MS. ANA D LICANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
310 DIVISION ST, GRANDVIEW, WA 98930-1359
(509) 882-3659
Mailing address
210 ASH ST, GRANDVIEW, WA 98930-1319
(509) 882-5934
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00024915
WA
Other
Enumeration date
08/03/2009
Last updated
08/03/2009
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