Provider Demographics
NPI:1851166417
Name:RANSOM, MANDY LYNN
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:LYNN
Last Name:RANSOM
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 1:2502 BEHSHEL HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-5258
Mailing Address - Country:US
Mailing Address - Phone:360-747-3676
Mailing Address - Fax:
Practice Address - Street 1:2502 BEHSHEL HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-5258
Practice Address - Country:US
Practice Address - Phone:360-747-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAID-A3775359171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach