Provider Demographics
NPI:1134283708
Name:WOHLFORD, COLLEEN MICHELLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MICHELLE
Last Name:WOHLFORD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MICHELLE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:101 EAST MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272
Mailing Address - Country:US
Mailing Address - Phone:360-863-0642
Mailing Address - Fax:360-794-7236
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1519
Practice Address - Country:US
Practice Address - Phone:360-863-0642
Practice Address - Fax:360-794-7236
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist