Provider Demographics
NPI:1215173695
Name:EHNAT, THERESA ANN (LMP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:EHNAT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:ANN
Other - Last Name:EHNAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:1206 S 11TH ST
Mailing Address - Street 2:#15 A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4091
Mailing Address - Country:US
Mailing Address - Phone:253-272-1825
Mailing Address - Fax:
Practice Address - Street 1:1206 S 11TH ST
Practice Address - Street 2:#15 A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4091
Practice Address - Country:US
Practice Address - Phone:253-272-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016412171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0185023OtherLABOR AND INDUSTRIES OF WASHINGTON