Healthcare Provider Details

I. General information

NPI: 1912640855
Provider Name (Legal Business Name): SOUND PAIN ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6808 220TH ST SW STE 201
MOUNTLAKE TERRACE WA
98043-2187
US

IV. Provider business mailing address

4029 NORTHWEST AVE STE 301
BELLINGHAM WA
98226-9077
US

V. Phone/Fax

Practice location:
  • Phone: 360-839-6778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

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