Healthcare Provider Details

I. General information

NPI: 1902932775
Provider Name (Legal Business Name): KENDRA GUDZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38579 SE RIVER ST #13
SNOQUALMIE WA
98065
US

IV. Provider business mailing address

PO BOX 2043
NORTH BEND WA
98045-2043
US

V. Phone/Fax

Practice location:
  • Phone: 425-443-2515
  • Fax:
Mailing address:
  • Phone: 425-443-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17224
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: