Provider Demographics
NPI:1053698571
Name:BLAUFUSS, KIM (LAC)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BLAUFUSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N HERON DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-9684
Mailing Address - Country:US
Mailing Address - Phone:360-773-1566
Mailing Address - Fax:360-313-6458
Practice Address - Street 1:1711 N HERON DR
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9684
Practice Address - Country:US
Practice Address - Phone:360-773-1566
Practice Address - Fax:360-313-6458
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60251668171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist