Provider Demographics
NPI:1548359870
Name:MCDOUGALL, FELICITY J (LMP)
Entity type:Individual
Prefix:MISS
First Name:FELICITY
Middle Name:J
Last Name:MCDOUGALL
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 1:28608 80TH AVENUE CT S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-7715
Mailing Address - Country:US
Mailing Address - Phone:253-228-6160
Mailing Address - Fax:
Practice Address - Street 1:1720 S 72ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1245
Practice Address - Country:US
Practice Address - Phone:253-475-6779
Practice Address - Fax:253-475-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist