Healthcare Provider Details

I. General information

NPI: 1780429167
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21509 STATE ROUTE 410 E STE 1A
BONNEY LAKE WA
98391-4104
US

IV. Provider business mailing address

4029 NORTHWEST AVE STE 301
BELLINGHAM WA
98226-9077
US

V. Phone/Fax

Practice location:
  • Phone: 253-891-2160
  • Fax: 253-981-2171
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSH LEDER
Title or Position: CEO
Credential:
Phone: 801-641-5613