Provider Demographics
NPI:1013338904
Name:GONZOL, SARAH (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GONZOL
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 1:132 R ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5875
Mailing Address - Country:US
Mailing Address - Phone:206-304-3107
Mailing Address - Fax:
Practice Address - Street 1:1299 156TH AVE NE STE 123
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-7562
Practice Address - Country:US
Practice Address - Phone:425-614-4000
Practice Address - Fax:425-641-0880
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60397091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist