Healthcare Provider Details

I. General information

NPI: 1124440797
Provider Name (Legal Business Name): JENNIFER VIGIL-BINGMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1242 11TH ST
CLARKSTON WA
99403-2815
US

IV. Provider business mailing address

19226 E RIVER WALK LN
SPOKANE VALLEY WA
99016-8404
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-2523
  • Fax:
Mailing address:
  • Phone: 208-791-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 60432125
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: