Provider Demographics
NPI:1669835492
Name:MOND, GRISELDE ARTEMIS
Entity Type:Individual
Prefix:
First Name:GRISELDE
Middle Name:ARTEMIS
Last Name:MOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:MARIA
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1138 N.W. MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3710
Mailing Address - Country:US
Mailing Address - Phone:206-783-0404
Mailing Address - Fax:206-782-8955
Practice Address - Street 1:1138 N.W. MARKET ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3710
Practice Address - Country:US
Practice Address - Phone:206-783-0404
Practice Address - Fax:206-782-8955
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60522168225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist