Provider Demographics
NPI:1366713497
Name:WALSH, SHERILYN J (LMP)
Entity type:Individual
Prefix:
First Name:SHERILYN
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 SE 1ST ST STE 118
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7478
Mailing Address - Country:US
Mailing Address - Phone:360-608-8854
Mailing Address - Fax:360-433-9809
Practice Address - Street 1:19206 SE 1ST ST STE 118
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7478
Practice Address - Country:US
Practice Address - Phone:360-433-9016
Practice Address - Fax:360-433-9809
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015200225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist