Healthcare Provider Details

I. General information

NPI: 1043096647
Provider Name (Legal Business Name): JAKE GOYDEN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 E MADISON ST
SEATTLE WA
98112-4214
US

IV. Provider business mailing address

2910 E MADISON ST
SEATTLE WA
98112-4214
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-1883
  • Fax: 206-649-9954
Mailing address:
  • Phone: 206-659-1883
  • Fax: 206-649-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACOB GOYDEN
Title or Position: PRINCIPAL
Credential: MD
Phone: 206-659-1883