Provider Demographics
NPI:1629131065
Name:MADDOX, EMILY ELIZABETH WOLF (LMT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH WOLF
Last Name:MADDOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 FREMONT AVE N
Mailing Address - Street 2:APT #8
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7753
Mailing Address - Country:US
Mailing Address - Phone:206-478-0477
Mailing Address - Fax:206-523-5566
Practice Address - Street 1:7337 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5918
Practice Address - Country:US
Practice Address - Phone:206-523-9000
Practice Address - Fax:206-523-5566
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014794174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist