Provider Demographics
NPI:1023158318
Name:VODOPICH, DONNA R (LMP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:R
Last Name:VODOPICH
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 1:4097 JAMES STREET RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7736
Mailing Address - Country:US
Mailing Address - Phone:360-398-1988
Mailing Address - Fax:360-671-6877
Practice Address - Street 1:4097 JAMES STREET RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7736
Practice Address - Country:US
Practice Address - Phone:360-398-1988
Practice Address - Fax:360-671-6877
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016254225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0187083OtherDEPARTMENT OF L & I
WA5452AROtherREGENCE INSURANCE