Provider Demographics
NPI:1194176198
Name:GOODMANSON, AMANDA (LMP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GOODMANSON
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 1:11720 97TH LN NE
Mailing Address - Street 2:A310
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8958
Mailing Address - Country:US
Mailing Address - Phone:425-577-0107
Mailing Address - Fax:
Practice Address - Street 1:11720 97TH LN NE
Practice Address - Street 2:A310
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8958
Practice Address - Country:US
Practice Address - Phone:425-577-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60623346225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist