Healthcare Provider Details

I. General information

NPI: 1720827561
Provider Name (Legal Business Name): ASHLEY MARIE GOODSPEED PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE STE 200
ISSAQUAH WA
98029-5436
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-3030
  • Fax: 425-392-2564
Mailing address:
  • Phone: 425-507-0733
  • Fax: 425-283-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.PA.70155989
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: