Provider Demographics
NPI:1831319417
Name:MCILRATH, ANN LOUISE (LMP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:MCILRATH
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 1:9119 RIDGETOP BLVD NW STE 260
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8549
Mailing Address - Country:US
Mailing Address - Phone:360-516-6804
Mailing Address - Fax:360-516-6804
Practice Address - Street 1:9119 RIDGETOP BLVD.
Practice Address - Street 2:SUITE 260
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8549
Practice Address - Country:US
Practice Address - Phone:360-516-6804
Practice Address - Fax:360-516-6804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016221171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor