Provider Demographics
NPI:1043775158
Name:SLOUGH, MIKAYLA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:MARIE
Last Name:SLOUGH
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 1:901 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3128
Mailing Address - Country:US
Mailing Address - Phone:509-881-8844
Mailing Address - Fax:
Practice Address - Street 1:320 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2107
Practice Address - Country:US
Practice Address - Phone:509-663-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60923681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-1678119Medicaid