Provider Demographics
NPI:1104454230
Name:MAGOUN, BENJAMIN M (ND)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:MAGOUN
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34626 SE SWENSON DR APT A109
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5109
Mailing Address - Country:US
Mailing Address - Phone:814-462-4803
Mailing Address - Fax:
Practice Address - Street 1:34626 SE SWENSON DR APT A109
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5109
Practice Address - Country:US
Practice Address - Phone:814-462-4803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61057037175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath