MEDICARE: ADELLE POULIOT A.S., A.A.C., CPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1093240566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELLE POULIOT A.S., A.A.C., CPC

Provider Business Mailing Address
First Line	:	601 W FRANKLIN ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-3518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 W FRANKLIN ST
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-3518
Country	:	US
Telephone Number	:	360-338-5341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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