Healthcare Provider Details

I. General information

NPI: 1730099268
Provider Name (Legal Business Name): MARY'S LEGACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LEGION WAY SE FL 3
OLYMPIA WA
98501-1518
US

IV. Provider business mailing address

809 LEGION WAY SE FL 3
OLYMPIA WA
98501-1518
US

V. Phone/Fax

Practice location:
  • Phone: 425-499-8822
  • Fax:
Mailing address:
  • Phone: 425-499-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. TONYA LARRENDA MILLER
Title or Position: C PEER SUPPORT SPECIALIST
Credential: CPSS
Phone: 425-499-8822