Basic Information
| Provider Information | |||||||||
| NPI: | 1275749392 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODMAN | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8750 GREENWOOD AVE N | ||||||||
| Address2: | SUITE S-1 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981033679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067825789 | ||||||||
| FaxNumber: | 2067825794 | ||||||||
| Practice Location | |||||||||
| Address1: | 8750 GREENWOOD AVE N | ||||||||
| Address2: | SUITE S-1 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981033679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067825789 | ||||||||
| FaxNumber: | 2067825794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA00016447 | WA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | MA00016447 | 01 | WA | STATE OF WA LICENSE # | OTHER |