Provider Demographics
NPI:1356605950
Name:RUDY, ELLEN JANE (CPCP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:RUDY
Suffix:
Gender:F
Credentials:CPCP
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:RUDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPCP
Mailing Address - Street 1:8115 74TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7764
Mailing Address - Country:US
Mailing Address - Phone:425-418-4115
Mailing Address - Fax:360-651-7600
Practice Address - Street 1:3204 SMOKEY POINT DR
Practice Address - Street 2:SUITE # 201
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8476
Practice Address - Country:US
Practice Address - Phone:360-657-7040
Practice Address - Fax:360-651-7600
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0001389OtherDEPT OF LICENSING- LICENSED ARTIST OPERATOR