Provider Demographics
NPI:1598821159
Name:GISSEL, JONATHAN SCOT (LAC, DIPLAC)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOT
Last Name:GISSEL
Suffix:
Gender:M
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 12TH AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2484
Mailing Address - Country:US
Mailing Address - Phone:206-251-3067
Mailing Address - Fax:
Practice Address - Street 1:1605 12TH AVE STE 30
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2484
Practice Address - Country:US
Practice Address - Phone:206-251-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00001986171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist