Provider Demographics
NPI:1184234403
Name:GONDA, ELIZABETH LYNN
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LYNN
Last Name:GONDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NE NORTHGATE WAY APT 323
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6254
Mailing Address - Country:US
Mailing Address - Phone:952-836-9110
Mailing Address - Fax:
Practice Address - Street 1:525 NE NORTHGATE WAY APT 323
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6254
Practice Address - Country:US
Practice Address - Phone:952-836-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC12178171R00000X
WAMC56147171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter