Healthcare Provider Details

I. General information

NPI: 1760295919
Provider Name (Legal Business Name): MADELINE KUDLATA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW 50TH ST
SEATTLE WA
98107-5119
US

IV. Provider business mailing address

348 NW 48TH ST
SEATTLE WA
98107-3539
US

V. Phone/Fax

Practice location:
  • Phone: 206-789-6288
  • Fax:
Mailing address:
  • Phone: 262-408-0471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number61624065
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: