Provider Demographics
NPI:1780059899
Name:KOWATCH, JAMIE (RD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KOWATCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 NE 122ND WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:425-285-5877
Mailing Address - Fax:425-977-0277
Practice Address - Street 1:8423 MUKILTEO SPEEDWAY STE 102
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-285-5877
Practice Address - Fax:425-977-0227
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60418927133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered