Provider Demographics
NPI:1053604702
Name:FROUNFELTER, JUDY ANNE (LMP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANNE
Last Name:FROUNFELTER
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 1:7415 MOON VALLEY RD SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9461
Mailing Address - Country:US
Mailing Address - Phone:425-894-6958
Mailing Address - Fax:
Practice Address - Street 1:7650 SE 27TH ST
Practice Address - Street 2:SUITE 136
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3060
Practice Address - Country:US
Practice Address - Phone:206-275-3177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00000096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist