Provider Demographics
NPI:1871778449
Name:JONES, GWYNETH I (RD, CD)
Entity type:Individual
Prefix:
First Name:GWYNETH
Middle Name:I
Last Name:JONES
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 NE 94TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-3147
Mailing Address - Country:US
Mailing Address - Phone:206-369-1104
Mailing Address - Fax:
Practice Address - Street 1:13111 SE 274TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-8929
Practice Address - Country:US
Practice Address - Phone:206-296-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00002047133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered