Provider Demographics
NPI:1679830277
Name:RAGSDALE, CECELIA (LMP)
Entity Type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:
Last Name:RAGSDALE
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 1:12003 28TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9163
Mailing Address - Country:US
Mailing Address - Phone:425-422-2644
Mailing Address - Fax:
Practice Address - Street 1:211 W HILL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1404
Practice Address - Country:US
Practice Address - Phone:360-794-6620
Practice Address - Fax:360-794-9863
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004977172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA49748OtherLABOR & INDUSTRIES