MR. GARY CLAYTON ISHAM (NPI# 1114177169) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114177169 |
| Entity Type | Individual |
| Full Name | MR. GARY CLAYTON ISHAM |
| Credential | CDP |
| Practice Address |
17337 Reservation Rd La Conner WA 98257-8802 |
| Mailing Address |
17500 S Skyridge Dr Mount Vernon WA 98274-7768 |
| Practice Telephone | 3604661024 |
| Mailing Telephone | 4255016257 |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2014-10-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
CP00005949 | WA | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 199286 | 05 |
| Street Address |
17337 RESERVATION RD |
| City | LA CONNER |
| State | WA |
| Zip Code | 98257-8802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689132458 | Emma Mae Sadzewicz | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2019-03-11 |
| 1760992341 | Alette Ford | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2017-10-09 |
| 1235689381 | Swinomish Indian Tribal Community | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-10-12 |
| 1518415322 | Kelvin R Giles | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-09-21 |
| 1124473202 | Jacqueline Franco | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-04-26 |
| 1245691070 | Keith Harrison Ford | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-03-07 |
| 1568726313 | Amelia Felton | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2012-06-26 |
| 1346544400 | Mary Ellen Mabbott | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2011-01-04 |
| 1821221011 | Chad G Walker | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2009-09-03 |
| 1740413020 | Patricia J Harlan | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2009-09-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568088144 | Rsl La Conner, LLC | Assisted Living Facility | 204 N. 1st St, La Conner, WA 98257 | 2020-06-19 |
| 1255950572 | The Everett Clinic, Pllc | Family Medicine | 528 Myrtle Street, Laconner, WA 98257 | 2020-04-16 |
| 1205302262 | Thanh Nguyen | Pharmacist | 708 E. Morris St, La Conner, WA 98257 | 2018-10-17 |
| 1023590197 | Melissa Danielle Adair | Nurse Practitioner | 708 Morris Street, Suite B, La Conner, WA 98257 | 2018-09-05 |
| 1013363886 | Steven Bruce Gooding | Counselor | 17400 Reservation Rd., La Conner, WA 98257 | 2016-05-10 |
| 1639550643 | Skagit County Fire District 13 | Ambulance | 17433 Snee-oosh Rd, La Conner, WA 98257 | 2015-06-16 |
| 1679909360 | Nina Marie Wawrzyniec | Chiropractor | 125 Washington Street, Laconner, WA 98257 | 2013-09-25 |
| 1669805180 | Reidun E Pederson | Registered Nurse | 403 State St., La Conner, WA 98257 | 2013-08-20 |
| 1326390527 | Susan Jane Erickson | Speech-Language Pathologist | 305 N. 6th, La Conner, WA 98257 | 2012-10-11 |
| 1528331469 | Charles Evert Larsson | Family Medicine | 528 Myrtle Avenue, La Conner, WA 98257 | 2012-02-22 |
| Find all providers in zip 98257 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184223869 | Season Silk | Counselor | 523 Rainier St, La Conner, WA 98257-4707 | 2020-10-22 |
| 1013363886 | Steven Bruce Gooding | Counselor | 17400 Reservation Rd., La Conner, WA 98257 | 2016-05-10 |
| 1689132458 | Emma Mae Sadzewicz | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2019-03-11 |
| 1760992341 | Alette Ford | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2017-10-09 |
| 1235689381 | Swinomish Indian Tribal Community | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-10-12 |
| 1518415322 | Kelvin R Giles | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-09-21 |
| 1124473202 | Jacqueline Franco | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-04-26 |
| 1245691070 | Keith Harrison Ford | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2016-03-07 |
| 1568726313 | Amelia Felton | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2012-06-26 |
| 1346544400 | Mary Ellen Mabbott | Counselor | 17337 Reservation Rd, La Conner, WA 98257-8802 | 2011-01-04 |
| Find all providers in LA CONNER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.