Provider Demographics
NPI:1578768719
Name:CLOUGH THOMPSON, JULIE KAY (LMP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:CLOUGH THOMPSON
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 1:298 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2447
Mailing Address - Country:US
Mailing Address - Phone:509-685-0998
Mailing Address - Fax:509-684-8685
Practice Address - Street 1:298 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2447
Practice Address - Country:US
Practice Address - Phone:509-685-0998
Practice Address - Fax:509-684-8685
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA024201MA00014278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist