Provider Demographics
NPI:1285865048
Name:GOOCH, JASON WILLIAM (ND, LMP)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:GOOCH
Suffix:
Gender:M
Credentials:ND, LMP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:18528 FIRLANDS WAY N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-629-4343
Mailing Address - Fax:206-801-7365
Practice Address - Street 1:18528 FIRLANDS WAY N
Practice Address - Street 2:SUITE D
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3985
Practice Address - Country:US
Practice Address - Phone:206-629-4343
Practice Address - Fax:206-801-7365
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60198440175F00000X
WAMA00019095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist