Healthcare Provider Details

I. General information

NPI: 1740959477
Provider Name (Legal Business Name): JAMILYN PURVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W MARKET ST STE 204B
ABERDEEN WA
98520-6206
US

IV. Provider business mailing address

PO BOX 1021
WESTPORT WA
98595-1021
US

V. Phone/Fax

Practice location:
  • Phone: 360-506-0059
  • Fax:
Mailing address:
  • Phone: 530-249-7539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.61644803
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: