Provider Demographics
NPI:1710192380
Name:HARROUN, AMY ELISE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELISE
Last Name:HARROUN
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 1:8115 TRIMBLE LN SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6882
Mailing Address - Country:US
Mailing Address - Phone:360-352-1422
Mailing Address - Fax:360-352-1422
Practice Address - Street 1:222 KENYON ST NW
Practice Address - Street 2:SUITE 1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4553
Practice Address - Country:US
Practice Address - Phone:360-790-6445
Practice Address - Fax:360-352-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA159296OtherL & I PROVIDER NUMBER