Provider Demographics
NPI:1114050101
Name:LOUGH, JULIE ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:LOUGH
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 1:19421 81ST PL W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6223
Mailing Address - Country:US
Mailing Address - Phone:425-344-5571
Mailing Address - Fax:425-673-7918
Practice Address - Street 1:13000 BEVERLY PARK RD
Practice Address - Street 2:SUITE K
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5849
Practice Address - Country:US
Practice Address - Phone:425-344-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist