Healthcare Provider Details

I. General information

NPI: 1255894101
Provider Name (Legal Business Name): LUCY LANGDON GOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 REPUBLICAN ST # 358047
SEATTLE WA
98109-4725
US

IV. Provider business mailing address

201 16TH AVE E
SEATTLE WA
98112-5226
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-2556
  • Fax:
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD61179445
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61179445
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: