Basic Information
| Provider Information | |||||||||
| NPI: | 1285885053 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODING | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | KAY | ||||||||
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| NameSuffix: | |||||||||
| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3360 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 413 LILLY RD NE | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985065133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604937567 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133N00000X | N | Dietary & Nutritional Service Providers | Nutritionist | 133NN1002X | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1004X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Pediatric | 133VN1005X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Renal | 133V00000X | DI00000113 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133VN1006X | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
ID Information
| ID | Type | State | Issuer | Description | DI00000113 | 01 | WA | DIETITIAN CERTIFICATION | OTHER | R-708356 | 01 | WA | CERTIFICATION NUMBER | OTHER |