MEDICARE: JEANETTE MICHELLE BEAL 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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1790570190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE MICHELLE BEAL CPC

Provider Business Mailing Address
First Line	:	4714 NE 72ND AVE APT 118
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-8119
Country	:	US
Telephone Number	:	360-831-7553
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 NE 72ND AVE APT 118
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98661-8119
Country	:	US
Telephone Number	:	360-831-7553
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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Directions to “ JEANETTE MICHELLE BEAL CPC” Practice Location

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