Provider Demographics
NPI:1629614615
Name:GONSER, JENNIFER BARBARA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BARBARA
Last Name:GONSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:GONSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:20818 44TH AVE W STE 270-P
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7709
Mailing Address - Country:US
Mailing Address - Phone:425-672-2716
Mailing Address - Fax:425-672-2720
Practice Address - Street 1:20818 44TH AVE W STE 270-P
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7709
Practice Address - Country:US
Practice Address - Phone:425-672-2716
Practice Address - Fax:425-672-2720
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT61533040225X00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician