Provider Demographics
NPI:1578253415
Name:BOHON FERRER, WENDY ERNESTINA
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ERNESTINA
Last Name:BOHON FERRER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 SE 7TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-6004
Mailing Address - Country:US
Mailing Address - Phone:615-584-4810
Mailing Address - Fax:
Practice Address - Street 1:12200 SE 7TH ST APT A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6004
Practice Address - Country:US
Practice Address - Phone:615-584-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61399868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist