Individual
TRACI M PETERSON HOUGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
408 MAIN STREET, CONCONULLY, WA 98819
(509) 826-5548
Mailing address
PO BOX 324, CONCONULLY, WA 98819-0324
(509) 826-5548
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00017693
WA
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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