Individual
ELLEN JANE RUDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPCP
Contact information
Practice address
3204 SMOKEY POINT DR, SUITE # 201, ARLINGTON, WA 98223-8476
(360) 657-7040
(360) 651-7600
Mailing address
8115 74TH PL NE, MARYSVILLE, WA 98270-7764
(425) 418-4115
(360) 651-7600
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001389
DEPT OF LICENSING- LICENSED ARTIST OPERATOR
WA
Enumeration date
06/28/2012
Last updated
11/08/2023
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