Healthcare Provider Details

I. General information

NPI: 1306714902
Provider Name (Legal Business Name): NORTHWEST BEAUTY CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 SE 192ND AVE STE 105
CAMAS WA
98607-7415
US

IV. Provider business mailing address

1905 SE 192ND AVE STE 105
CAMAS WA
98607-7415
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-7654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER MILLER
Title or Position: CRANIAL PROSTHESIS SPECIALIST
Credential:
Phone: 360-904-9681