Provider Demographics
NPI:1336670637
Name:MADEN, VALERIE (LMP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:MADEN
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 1:18811 NUTMEG ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9143
Mailing Address - Country:US
Mailing Address - Phone:360-999-0599
Mailing Address - Fax:
Practice Address - Street 1:18234 SARGENT RD SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-8554
Practice Address - Country:US
Practice Address - Phone:360-273-9174
Practice Address - Fax:360-273-9683
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60674242225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist