Provider Demographics
NPI:1518204593
Name:STOCKHAUSEN, NATALIE (LMP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:STOCKHAUSEN
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 1:518 S 7TH ST APT 308
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2216
Mailing Address - Country:US
Mailing Address - Phone:253-970-0066
Mailing Address - Fax:
Practice Address - Street 1:518 S 7TH ST APT 308
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2216
Practice Address - Country:US
Practice Address - Phone:253-970-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA#MA60284809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist