Provider Demographics
NPI:1669690590
Name:RANSOM, JUDITH A (LMP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:RANSOM
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 1:8719 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2810
Mailing Address - Country:US
Mailing Address - Phone:509-922-6400
Mailing Address - Fax:
Practice Address - Street 1:303 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5227
Practice Address - Country:US
Practice Address - Phone:509-922-4458
Practice Address - Fax:509-922-8234
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019470174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00019470OtherMASSAGE PRACTITIONER
WA0175140OtherLABOR & INDUSTRIES
405207-00OtherNCBMT