MEDICARE: MS. GAYLE LONDON PATTERSON LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator	MC61146533	WA
3	171W00000X	Contractor	MA00016248	WA
4	101YM0800X	Mental Health Counselor	MC61146533	WA

General Provider Information

NPI Number	:	1295944767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GAYLE LONDON PATTERSON LMP

Provider Business Mailing Address
First Line	:	38778 TINKER PL NE
Second Line	:
City	:	HANSVILLE
State	:	WA
Zip	:	98340-5500
Country	:	US
Telephone Number	:	425-760-5132
Fax Number	:

Provider Business Practice Location Address
First Line	:	9612 270TH ST NW
Second Line	:
City	:	STANWOOD
State	:	WA
Zip	:	98292-1906
Country	:	US
Telephone Number	:	360-629-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	03/20/2025

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