Individual
BRENDA LYNN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AT,C
Contact information
Practice address
1508 136TH ST SE, MILL CREEK, WA 98012-5310
(425) 385-7038
(425) 385-7002
Mailing address
24205 54TH AVE W, MOUNTLAKE TERRACE, WA 98043-5515
(425) 697-2453
(425) 385-7002
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/11/2006
Last updated
07/08/2007
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