Provider Demographics
NPI:1245569557
Name:MANSFIELD, VALERIE JO (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:JO
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 W GAGE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-8104
Mailing Address - Country:US
Mailing Address - Phone:509-378-9651
Mailing Address - Fax:
Practice Address - Street 1:8382 W GAGE BLVD STE C
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8104
Practice Address - Country:US
Practice Address - Phone:509-378-9651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60098675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist