Provider Demographics
NPI:1598822199
Name:GAUTREAU, SYBIL HIGGINS (RD, MA)
Entity Type:Individual
Prefix:
First Name:SYBIL
Middle Name:HIGGINS
Last Name:GAUTREAU
Suffix:
Gender:F
Credentials:RD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7729 120TH PL SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98056-9190
Mailing Address - Country:US
Mailing Address - Phone:425-226-9823
Mailing Address - Fax:
Practice Address - Street 1:3001 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4122
Practice Address - Country:US
Practice Address - Phone:206-296-4700
Practice Address - Fax:206-296-0568
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI0000223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA832588Medicaid
328666OtherNATIONAL REGIATRATION #
WADI00000223OtherWA. LICENSE NUMBER