MEDICARE: GABRIELLE ANN OGAN SON

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	106S00000X	Behavior Technician
2	163W00000X	Registered Nurse	RN61208688	WA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61603038	WA

General Provider Information

NPI Number	:	1700417938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ANN OGAN SON

Provider Business Mailing Address
First Line	:	1622 ORIOLE LN NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-4342
Country	:	US
Telephone Number	:	360-556-9727
Fax Number	:

Provider Business Practice Location Address
First Line	:	2475 140TH AVE NE BLDG C
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-1892
Country	:	US
Telephone Number	:	425-827-4600
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	11/18/2024

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