Provider Demographics
NPI:1053618942
Name:WARD, CORRIE D (LMP)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:D
Last Name:WARD
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 1:3606 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2235
Mailing Address - Country:US
Mailing Address - Phone:360-693-7781
Mailing Address - Fax:360-693-1688
Practice Address - Street 1:3606 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2235
Practice Address - Country:US
Practice Address - Phone:360-693-7781
Practice Address - Fax:360-693-1688
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60190537225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist