Individual
MR. KENNETH D SAUCKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
3333 HARRISON AVE NW, SUITE 102, OLYMPIA, WA 98502-5049
(360) 292-7245
(360) 292-7247
Mailing address
PO BOX 11009, OLYMPIA, WA 98508-1009
(360) 352-2037
(360) 292-7247
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA00017335
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00017335
MASSAGE PRACTICIONER
WA
Enumeration date
02/04/2007
Last updated
01/11/2008
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