Provider Demographics
NPI:1952434805
Name:SKOOG, ANNE CATHRYN (LMP LICENSED MASSAGE)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:CATHRYN
Last Name:SKOOG
Suffix:
Gender:F
Credentials:LMP LICENSED MASSAGE
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:CATHRYN
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 W MCDOUGALL ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2242
Mailing Address - Country:US
Mailing Address - Phone:425-501-0127
Mailing Address - Fax:
Practice Address - Street 1:134 W MCDOUGALL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2242
Practice Address - Country:US
Practice Address - Phone:425-501-0127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA21729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist