Provider Demographics
NPI:1497871149
Name:WOLTHAUSEN, WENDY ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:WOLTHAUSEN
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:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-0652
Mailing Address - Country:US
Mailing Address - Phone:425-359-8338
Mailing Address - Fax:425-334-5041
Practice Address - Street 1:9623 32ND ST SE
Practice Address - Street 2:HWY 9 OFFICE PARK BLDG D - SUITE 113
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-5779
Practice Address - Country:US
Practice Address - Phone:425-359-8338
Practice Address - Fax:425-334-5041
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist