Provider Demographics
NPI:1871637439
Name:LONGSWORTH, DONNA JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4606 350TH ST E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9752
Mailing Address - Country:US
Mailing Address - Phone:253-875-6400
Mailing Address - Fax:
Practice Address - Street 1:22705 MERIDIAN AVE E
Practice Address - Street 2:STE A
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7098
Practice Address - Country:US
Practice Address - Phone:253-875-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020280225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist