Healthcare Provider Details

I. General information

NPI: 1144846262
Provider Name (Legal Business Name): AIMEE K GALLO CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

1037 NE 65TH ST # 120
SEATTLE WA
98115-6655
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5499
  • Fax:
Mailing address:
  • Phone: 206-227-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60953190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: