Provider Demographics
NPI:1922431675
Name:MULLIGAN, JAMIE E (LMP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:MULLIGAN
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 1:12 BELLWETHER WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2914
Mailing Address - Country:US
Mailing Address - Phone:360-366-4216
Mailing Address - Fax:360-366-4241
Practice Address - Street 1:12 BELLWETHER WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2914
Practice Address - Country:US
Practice Address - Phone:360-366-4216
Practice Address - Fax:360-366-4241
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60245100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist