Provider Demographics
NPI:1366054926
Name:FREEMAN, MONICA MARCELINA (MC5750, SC5665)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARCELINA
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MC5750, SC5665
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 S 114TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-3242
Mailing Address - Country:US
Mailing Address - Phone:206-355-3544
Mailing Address - Fax:206-971-5030
Practice Address - Street 1:8008 S 114TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-3242
Practice Address - Country:US
Practice Address - Phone:206-355-3544
Practice Address - Fax:206-971-5030
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC5665171R00000X
WAMC5750171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter