MEDICARE: WENDY ACORN LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	MA00004249	WA

General Provider Information

NPI Number	:	1992957674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ACORN LMP

Provider Business Mailing Address
First Line	:	5110 S FRONTENAC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3432
Country	:	US
Telephone Number	:	206-760-0199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 44TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2102
Country	:	US
Telephone Number	:	206-261-0160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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