Provider Demographics
NPI:1689245284
Name:LAUDERDALE, MONICA (LAC EAMP, LMT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LAUDERDALE
Suffix:
Gender:F
Credentials:LAC EAMP, LMT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:WITTGOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, EAMP, LMT
Mailing Address - Street 1:2825 BOUNDARY ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2825 BOUNDARY ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-3617
Practice Address - Country:US
Practice Address - Phone:360-870-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist