Provider Demographics
NPI:1760960652
Name:GOUDY, VICTORIA (LMT, ND)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GOUDY
Suffix:
Gender:F
Credentials:LMT, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 EMERICK RD
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-9139
Mailing Address - Country:US
Mailing Address - Phone:419-571-8643
Mailing Address - Fax:
Practice Address - Street 1:920 EMERICK RD
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-9139
Practice Address - Country:US
Practice Address - Phone:419-571-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175F00000X
WA60517638225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist