Healthcare Provider Details

I. General information

NPI: 1639185655
Provider Name (Legal Business Name): KATHLEEN MARY GRIFFIN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 NE 20TH AVE
VANCOUVER WA
98686-6410
US

IV. Provider business mailing address

5152 M COURT
WASHOUGAL WASHINGTON WA
98671
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-7373
  • Fax: 360-882-7673
Mailing address:
  • Phone: 360-831-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00022489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: