Gwendolyn Kathleen Shattuck, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61583202 Issued in WA

Practice address

19519 38TH Ave NE
Lake Forest Park, WA 98155-2609

Phone

(206) 235-6694

NPI assigned

Nov 25, 2024

Last updated

Nov 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732492800000",
    "number": "1457177420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19519 38TH AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981552609",
            "telephone_number": "206-235-6694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19519 38TH AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981552609",
            "telephone_number": "206-235-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "GWENDOLYN",
        "middle_name": "KATHLEEN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61583202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aracelly Salazar
• Laura Sandusky
• Jessica Sather, LMFTA
• Andrea Eva Schommer, PHARM D.
• Zachary Shaeffer, LICSW
• Anne Shumway-Cook, PT, PHD
• Bonita Shuffain Siegel, LICSW
• Haylee R Sirb
• Kristina Smart, MS
• Brian D Smith, PHD, M.ED

• Massage Therapist in Lake Forest Park, WA
• Providers in Lake Forest Park, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.