Provider Demographics
NPI:1275868655
Name:WOODBURY, CELEEN MARIE
Entity Type:Individual
Prefix:MRS
First Name:CELEEN
Middle Name:MARIE
Last Name:WOODBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CELEEN
Other - Middle Name:MARIE
Other - Last Name:WOODBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:3929 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-8642
Mailing Address - Country:US
Mailing Address - Phone:360-341-4362
Mailing Address - Fax:
Practice Address - Street 1:3929 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-8642
Practice Address - Country:US
Practice Address - Phone:360-341-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist