Provider Demographics
NPI:1235467168
Name:BUE-PETERSON, BONNIE CELESTIA (LMT)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:CELESTIA
Last Name:BUE-PETERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2257
Mailing Address - Country:US
Mailing Address - Phone:360-639-7781
Mailing Address - Fax:360-693-1688
Practice Address - Street 1:3606 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2257
Practice Address - Country:US
Practice Address - Phone:360-693-7781
Practice Address - Fax:360-693-1688
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60088320225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist