Provider Demographics
NPI:1154606739
Name:BILODEAU, MICHELLE (MAOM, LAC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BILODEAU
Suffix:
Gender:F
Credentials:MAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CATON WAY SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1119
Mailing Address - Country:US
Mailing Address - Phone:360-754-1396
Mailing Address - Fax:360-753-4288
Practice Address - Street 1:2010 CATON WAY SW
Practice Address - Street 2:SUITE 202
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1119
Practice Address - Country:US
Practice Address - Phone:360-754-1396
Practice Address - Fax:360-753-4288
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60219265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093002602OtherGROUP NPI