Provider Demographics
NPI:1346599008
Name:BILLINGSLEY, WHITNEY MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MARIE
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MARIE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 SE COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1803
Mailing Address - Country:US
Mailing Address - Phone:208-899-1929
Mailing Address - Fax:
Practice Address - Street 1:828 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4059
Practice Address - Country:US
Practice Address - Phone:509-522-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00024247171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 00024247OtherWASHINGTON STATE MASSAGE PRACTITIONER LICENSE