Provider Demographics
NPI:1417194846
Name:SLOSSON, MOLLY ROSE (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:ROSE
Last Name:SLOSSON
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 1:16 BLACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-9338
Mailing Address - Country:US
Mailing Address - Phone:360-581-6654
Mailing Address - Fax:360-532-4324
Practice Address - Street 1:2017 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-2725
Practice Address - Country:US
Practice Address - Phone:360-532-0888
Practice Address - Fax:360-532-4324
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00018740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist