Provider Demographics
NPI:1598920829
Name:WOODWARD, MARY L (LMP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:WOODWARD
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 1:13606 NE 20TH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2011
Mailing Address - Country:US
Mailing Address - Phone:425-985-0882
Mailing Address - Fax:
Practice Address - Street 1:13606 NE 20TH ST
Practice Address - Street 2:STE. 307
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2011
Practice Address - Country:US
Practice Address - Phone:425-985-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist