Provider Demographics
NPI:1023702164
Name:WHITTIER, AUBREY J (MSOM LAC)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:J
Last Name:WHITTIER
Suffix:
Gender:F
Credentials:MSOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4527
Mailing Address - Country:US
Mailing Address - Phone:253-268-2170
Mailing Address - Fax:
Practice Address - Street 1:104 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4527
Practice Address - Country:US
Practice Address - Phone:253-268-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012161171100000X
WAAC61464324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist