Provider Demographics
NPI:1861033672
Name:MCPHERSON, AMY ANN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANN
Last Name:MCPHERSON
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98235-0006
Mailing Address - Country:US
Mailing Address - Phone:360-707-1711
Mailing Address - Fax:
Practice Address - Street 1:325 E GEORGE HOPPER RD STE 106
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3154
Practice Address - Country:US
Practice Address - Phone:360-707-2300
Practice Address - Fax:360-707-2026
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60977439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist