Individual provider Active NPI

Lakisha M. Dickens, LMP

  • Massage Therapist
  • Kent, WA
National Provider Identifier
1013284793
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA60240321 Issued in WA
Practice address
25012 104TH Ave SE
Ste C
Kent, WA 98030-2821
Phone
(253) 856-3477
Fax
(253) 856-3478
NPI assigned
Nov 22, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA60240321 WA Primary

Addresses

Primary practice location

25012 104TH Ave SE
Ste C
Kent, WA 98030-2821

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MA60240321WAMDMassage Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1013284793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25012 104TH AVE SE",
            "address_2": "STE C",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980302821",
            "telephone_number": "253-856-3477",
            "fax_number": "253-856-3478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKENS",
        "first_name": "LAKISHA",
        "middle_name": "M.",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-22",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60240321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.