Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003385253 |
---|---|
Provider Name | Grace Goldman |
First Address | Seattle, WA 98134-2417 |
Second Address | Seattle, WA 98134-2417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2018 |
Last Update Date | 16/11/2018 |