Provider Demographics
NPI:1073731030
Name:GEORGE, CATHY (LMP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:GEORGE
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 1:313 NW HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3105
Mailing Address - Country:US
Mailing Address - Phone:509-332-0927
Mailing Address - Fax:509-332-0927
Practice Address - Street 1:103 NE SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2639
Practice Address - Country:US
Practice Address - Phone:509-332-0927
Practice Address - Fax:509-332-0927
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012810174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist