MEDICARE: STEPHANIE GONIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor	LH60623174	WA

General Provider Information

NPI Number	:	1053731174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE GONIA

Provider Business Mailing Address
First Line	:	PO BOX 2569
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98213-0569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 AIRPORT WAY S # 424
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98134-2167
Country	:	US
Telephone Number	:	206-954-8947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	12/04/2020

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Directions to “ STEPHANIE GONIA ” Practice Location

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