Provider Demographics
NPI:1740642875
Name:DEE MCGONIGLE
Entity type:Organization
Organization Name:DEE MCGONIGLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGONIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-528-1930
Mailing Address - Street 1:4545 SAND POINT WAY NE
Mailing Address - Street 2:608
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3926
Mailing Address - Country:US
Mailing Address - Phone:206-528-1930
Mailing Address - Fax:
Practice Address - Street 1:4545 SAND POINT WAY NE
Practice Address - Street 2:608
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3926
Practice Address - Country:US
Practice Address - Phone:206-528-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00008976320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities