Provider Demographics
NPI:1619017290
Name:MCDUFFIE, JOAN (LMP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MCDUFFIE
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 1:17620 80TH AVE NE APT 332
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-6622
Mailing Address - Country:US
Mailing Address - Phone:425-205-9247
Mailing Address - Fax:
Practice Address - Street 1:17917 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6384
Practice Address - Country:US
Practice Address - Phone:425-483-5594
Practice Address - Fax:425-487-0727
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist