Provider Demographics
NPI:1972151801
Name:GORDON, ANNE ELIZABETH (LAC, EAMP)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:GORDON
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5404
Mailing Address - Country:US
Mailing Address - Phone:425-305-3736
Mailing Address - Fax:
Practice Address - Street 1:607 MARKET ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-5404
Practice Address - Country:US
Practice Address - Phone:425-305-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60923383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty