Provider Demographics
NPI:1659408193
Name:CASON, GWEN A (LMP)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:A
Last Name:CASON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5495
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5495
Mailing Address - Country:US
Mailing Address - Phone:425-772-2414
Mailing Address - Fax:425-258-3023
Practice Address - Street 1:4629 168TH ST SW
Practice Address - Street 2:B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-8640
Practice Address - Country:US
Practice Address - Phone:425-722-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist