Healthcare Provider Details

I. General information

NPI: 1780059899
Provider Name (Legal Business Name): JAMIE KOWATCH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 MUKILTEO SPEEDWAY STE 102
MUKILTEO WA
98275
US

IV. Provider business mailing address

11335 NE 122ND WAY STE 105
KIRKLAND WA
98034-6933
US

V. Phone/Fax

Practice location:
  • Phone: 425-285-5877
  • Fax: 425-977-0227
Mailing address:
  • Phone: 425-285-5877
  • Fax: 425-977-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60418927
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: