Provider Demographics
NPI:1720122377
Name:MONZON, MICHELLE ANN (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:MONZON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CRIPPEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:9901 NE 7TH AVE
Mailing Address - Street 2:STE A 201
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4537
Mailing Address - Country:US
Mailing Address - Phone:360-573-4660
Mailing Address - Fax:360-694-4024
Practice Address - Street 1:9901 NE 7TH AVE
Practice Address - Street 2:STE A 201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4537
Practice Address - Country:US
Practice Address - Phone:360-573-4660
Practice Address - Fax:360-694-4024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010401174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist