Provider Demographics
NPI:1053508929
Name:WALGAMOTT, MARY (LMP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WALGAMOTT
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 1:1220 116TH AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3826
Mailing Address - Country:US
Mailing Address - Phone:425-637-0094
Mailing Address - Fax:
Practice Address - Street 1:1220 116TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3826
Practice Address - Country:US
Practice Address - Phone:425-637-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist