Individual
PENNY GOUDELOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1100 PACIFIC AVE, SUITE 202, EVERETT, WA 98201-4261
(425) 388-4075
Mailing address
18012 W VALLEY HWY, STE 101, KENT, WA 98032-2924
(425) 291-3300
(425) 291-5300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10005160
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8485898
—
WA
Enumeration date
04/11/2007
Last updated
04/14/2020
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