MEDICARE: ANDREW JAMES GWINN MA

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	101YM0800X	Mental Health Counselor	MC60857842	WA

General Provider Information

NPI Number	:	1487145660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW JAMES GWINN MA

Provider Business Mailing Address
First Line	:	2700 ALKI AVE SW APT 202
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-2867
Country	:	US
Telephone Number	:	360-581-0481
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WESTLAKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5802
Country	:	US
Telephone Number	:	206-858-1177
Fax Number	:

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

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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