Provider Demographics
NPI:1114195328
Name:BJORK, LINDA LUCILE (CFM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LUCILE
Last Name:BJORK
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21505 145TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7538
Mailing Address - Country:US
Mailing Address - Phone:360-897-8398
Mailing Address - Fax:360-897-8684
Practice Address - Street 1:21505 145TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7538
Practice Address - Country:US
Practice Address - Phone:360-897-8398
Practice Address - Fax:360-897-8684
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9047101Medicaid
WA9047101Medicaid