Provider Demographics
NPI:1851520951
Name:BARRETT, AUDREY M (LICENSED ACUPUNCTURI)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:MARIA
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5369
Mailing Address - Country:US
Mailing Address - Phone:509-828-3849
Mailing Address - Fax:
Practice Address - Street 1:717 E 1ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922
Practice Address - Country:US
Practice Address - Phone:509-828-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1362171100000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist