Provider Demographics
NPI:1457649600
Name:GILCHRIST, AMANDA VAUGHN (LMP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VAUGHN
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LAINE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3923 S BURNS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5229
Mailing Address - Country:US
Mailing Address - Phone:206-605-8181
Mailing Address - Fax:
Practice Address - Street 1:3923 S BURNS ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5229
Practice Address - Country:US
Practice Address - Phone:206-605-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60012075225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist