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NPI Code Detail

MEDICARE: MS. JENNIFER KRISTINE CASTANETO CDP

MEDICARE: MS. JENNIFER KRISTINE CASTANETO CDP
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCP 00001359WA

General Provider Information

NPI Number : 1295106300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER KRISTINE CASTANETO CDP
Provider Business Mailing Address
First Line : 235 S 3RD ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2255
Country : US
Telephone Number : 360-584-5803
Fax Number :
Provider Business Practice Location Address
First Line : 235 S 3RD ST
Second Line :
City : SHELTON
State : WA
Zip : 98584-2255
Country : US
Telephone Number : 360-584-5803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2015
Last Update Date : 10/14/2015

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