Individual
DIANNA FENNESSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
415 SE 177TH AVE, VANCOUVER, WA 98683-4201
(360) 980-5414
Mailing address
2952 NW IVY LN, CAMAS, WA 98607-7958
(360) 833-1538
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00017053
WA
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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