Provider Demographics
NPI:1093825184
Name:BOLINGER, MARY KATHERINE (LMP, LAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:BOLINGER
Suffix:
Gender:F
Credentials:LMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 E HELEN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3617
Mailing Address - Country:US
Mailing Address - Phone:206-774-1663
Mailing Address - Fax:
Practice Address - Street 1:911 WESTERN AVE
Practice Address - Street 2:SUITE 306A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3605
Practice Address - Country:US
Practice Address - Phone:206-774-1663
Practice Address - Fax:206-260-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist