Provider Demographics
NPI:1396222691
Name:GUTHRIE, SAMANTHA ROSE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ROSE
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 4TH AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98161-1017
Mailing Address - Country:US
Mailing Address - Phone:206-622-9001
Mailing Address - Fax:206-622-4311
Practice Address - Street 1:1215 4TH AVE STE 1000
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98161-1017
Practice Address - Country:US
Practice Address - Phone:206-622-9001
Practice Address - Fax:206-622-4311
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60892736175F00000X
WAAC60901212171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2118781Medicaid