Provider Demographics
NPI:1700515251
Name:WOGOMAN, AMBER JOANNA (LMT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JOANNA
Last Name:WOGOMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 REITEN RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6028
Mailing Address - Country:US
Mailing Address - Phone:206-915-7243
Mailing Address - Fax:
Practice Address - Street 1:3215 W LYNN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3944
Practice Address - Country:US
Practice Address - Phone:206-915-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00020386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty