Provider Demographics
NPI:1679724322
Name:WASHINGTON, DENISE ELAINE
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ELAINE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22053 NEPTUNE LN
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-3107
Mailing Address - Country:US
Mailing Address - Phone:708-528-8549
Mailing Address - Fax:708-283-4864
Practice Address - Street 1:22053 NEPTUNE LN
Practice Address - Street 2:
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-3107
Practice Address - Country:US
Practice Address - Phone:708-528-8549
Practice Address - Fax:708-283-4864
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter