Healthcare Provider Details

I. General information

NPI: 1629614615
Provider Name (Legal Business Name): JENNIFER BARBARA GONSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY GONSER MS, OTR/L

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20818 44TH AVE W STE 270-P
LYNNWOOD WA
98036-7709
US

IV. Provider business mailing address

20818 44TH AVE W STE 270-P
LYNNWOOD WA
98036-7709
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-2716
  • Fax: 425-672-2720
Mailing address:
  • Phone: 425-672-2716
  • Fax: 425-672-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT61533040
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: