Healthcare Provider Details

I. General information

NPI: 1659589968
Provider Name (Legal Business Name): MARY U. DOUCET LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14819 E 20TH AVE
SPOKANE VALLEY WA
99037-9498
US

IV. Provider business mailing address

14819 E 20TH AVE
SPOKANE VALLEY WA
99037-9498
US

V. Phone/Fax

Practice location:
  • Phone: 509-475-3177
  • Fax:
Mailing address:
  • Phone: 509-475-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA17545
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA17545
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: