Provider Demographics
NPI:1912982976
Name:GILPATRICK, CHARLENE JEAN (LMP LMT NCTMB)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:JEAN
Last Name:GILPATRICK
Suffix:
Gender:F
Credentials:LMP LMT NCTMB
Other - Prefix:
Other - First Name:COOKIE
Other - Middle Name:JEAN
Other - Last Name:GILPATRICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP LMT NCTMB
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98650-0259
Mailing Address - Country:US
Mailing Address - Phone:509-395-2468
Mailing Address - Fax:509-395-2468
Practice Address - Street 1:3 MURDOCK WAY
Practice Address - Street 2:
Practice Address - City:TROUT LAKE
Practice Address - State:WA
Practice Address - Zip Code:98650
Practice Address - Country:US
Practice Address - Phone:509-395-2468
Practice Address - Fax:509-395-2468
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6299225700000X
OR4614225700000X
29660100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA48871OtherL&I