Provider Demographics
NPI:1871978791
Name:WASHINGTON, PRISCILLA MARIE
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:MARIE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2106
Mailing Address - Country:US
Mailing Address - Phone:316-267-5437
Mailing Address - Fax:316-267-5444
Practice Address - Street 1:3223 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2106
Practice Address - Country:US
Practice Address - Phone:316-267-5437
Practice Address - Fax:316-267-5444
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist