Provider Demographics
NPI:1558573022
Name:DAMON, LONDA SUE (LMP)
Entity Type:Individual
Prefix:
First Name:LONDA
Middle Name:SUE
Last Name:DAMON
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 1:14206 FIELD RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9144
Mailing Address - Country:US
Mailing Address - Phone:360-757-6024
Mailing Address - Fax:360-757-0798
Practice Address - Street 1:9015 AVON ALLEN RD
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:WA
Practice Address - Zip Code:98232-8703
Practice Address - Country:US
Practice Address - Phone:360-757-6024
Practice Address - Fax:360-757-0798
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0021292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist