Provider Demographics
NPI:1336200955
Name:BUJACICH, TERESA (ND, LAC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BUJACICH
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-1236
Mailing Address - Country:US
Mailing Address - Phone:360-331-7331
Mailing Address - Fax:360-331-7343
Practice Address - Street 1:2843 HOWARD RD
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9731
Practice Address - Country:US
Practice Address - Phone:360-331-7331
Practice Address - Fax:360-331-7343
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1329175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath