Provider Demographics
NPI:1447626973
Name:WASHINGTON, PATRICIA ASHLEY (LAC, DAOM, OMD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ASHLEY
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LAC, DAOM, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5520
Mailing Address - Country:US
Mailing Address - Phone:312-842-1229
Mailing Address - Fax:
Practice Address - Street 1:19740 GOVERNORS HWY STE 117
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2085
Practice Address - Country:US
Practice Address - Phone:708-914-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist