Provider Demographics
NPI:1871670208
Name:BONDICK, IRENE (LMP, CPMT)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BONDICK
Suffix:
Gender:F
Credentials:LMP, CPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 MARY AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3428
Mailing Address - Country:US
Mailing Address - Phone:206-419-7552
Mailing Address - Fax:
Practice Address - Street 1:1421 NW 70TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5340
Practice Address - Country:US
Practice Address - Phone:206-419-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021613174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist