Provider Demographics
NPI:1407031263
Name:PRIOLEAU, VONDA K (LMP)
Entity Type:Individual
Prefix:MRS
First Name:VONDA
Middle Name:K
Last Name:PRIOLEAU
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 1:1217 S 259TH PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-8917
Mailing Address - Country:US
Mailing Address - Phone:206-498-7075
Mailing Address - Fax:
Practice Address - Street 1:124 4TH AVE S STE 250
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5879
Practice Address - Country:US
Practice Address - Phone:253-854-5500
Practice Address - Fax:253-854-4098
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025045225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist