Provider Demographics
NPI:1629293014
Name:GONZALEZ, ALICIA ANN (ND)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9423
Mailing Address - Country:US
Mailing Address - Phone:360-755-7828
Mailing Address - Fax:360-331-2202
Practice Address - Street 1:1705 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9423
Practice Address - Country:US
Practice Address - Phone:360-755-7828
Practice Address - Fax:603-312-2023
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001131175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANT00001131OtherLICENSE
WA1629293014Medicaid