Provider Demographics
NPI:1164791653
Name:KASKI, JUDY LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:KASKI
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 1:601 W JONES ST
Mailing Address - Street 2:
Mailing Address - City:YACOLT
Mailing Address - State:WA
Mailing Address - Zip Code:98675-5625
Mailing Address - Country:US
Mailing Address - Phone:360-798-5949
Mailing Address - Fax:
Practice Address - Street 1:4916 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-2547
Practice Address - Country:US
Practice Address - Phone:360-798-5949
Practice Address - Fax:360-993-0428
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173C00000X
WAMA60259902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist