Provider Demographics
NPI:1003300245
Name:KIRSCH, MALLORIE J (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:J
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977A KITCHEN DICK RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-7579
Mailing Address - Country:US
Mailing Address - Phone:360-775-0655
Mailing Address - Fax:
Practice Address - Street 1:977A KITCHEN DICK RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-7579
Practice Address - Country:US
Practice Address - Phone:360-775-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60844376176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMW60844376OtherWASHINGTON STATE DEPARTMENT OF HEALTH