Provider Demographics
NPI:1053561670
Name:SUTHERLAND, BRENDA KAY (LMP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 1ST AVE
Mailing Address - Street 2:SUITE 231
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2216
Mailing Address - Country:US
Mailing Address - Phone:206-384-3368
Mailing Address - Fax:
Practice Address - Street 1:1528 SW 166TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3438
Practice Address - Country:US
Practice Address - Phone:206-384-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019884225700000X
WACN60115113376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide