Provider Demographics
NPI:1851552780
Name:HILTON, GWENDOLYN LUCILLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:LUCILLE
Last Name:HILTON
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 1:9808 109TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3061
Mailing Address - Country:US
Mailing Address - Phone:206-200-6806
Mailing Address - Fax:
Practice Address - Street 1:9808 109TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3061
Practice Address - Country:US
Practice Address - Phone:206-200-6806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024204225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist