Provider Demographics
NPI:1184810756
Name:ALLIS, CATHERINE JEAN (LMP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JEAN
Last Name:ALLIS
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 1:32425 2ND PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5773
Mailing Address - Country:US
Mailing Address - Phone:253-278-9383
Mailing Address - Fax:
Practice Address - Street 1:32425 2ND PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5773
Practice Address - Country:US
Practice Address - Phone:253-278-9383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist