Provider Demographics
NPI:1669679726
Name:GONZALEZ, LMP, TAMMY LEE ANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEE ANNE
Last Name:GONZALEZ, LMP
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 1:3512 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-5203
Mailing Address - Country:US
Mailing Address - Phone:360-993-2817
Mailing Address - Fax:
Practice Address - Street 1:616 NE 81ST ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8136
Practice Address - Country:US
Practice Address - Phone:360-573-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist