Provider Demographics
NPI:1104216860
Name:LUDLOW, BETH (LMP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:LUDLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13200 HADFIELD RD SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9540
Mailing Address - Country:US
Mailing Address - Phone:253-678-6118
Mailing Address - Fax:
Practice Address - Street 1:13200 HADFIELD RD SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9540
Practice Address - Country:US
Practice Address - Phone:253-678-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60487445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist