Healthcare Provider Details

I. General information

NPI: 1063321701
Provider Name (Legal Business Name): DIANE GODERE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 2ND ST
SNOHOMISH WA
98290-2934
US

IV. Provider business mailing address

2214 161ST AVE NE
SNOHOMISH WA
98290-7788
US

V. Phone/Fax

Practice location:
  • Phone: 360-996-9900
  • Fax:
Mailing address:
  • Phone: 360-996-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number70025033
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: