Healthcare Provider Details

I. General information

NPI: 1629048848
Provider Name (Legal Business Name): WWU CAMPUS HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 S COLLEGE AVE SUITE 101
COLLEGE PLACE WA
99324-1193
US

IV. Provider business mailing address

133 S COLLEGE AVE SUITE 101
COLLEGE PLACE WA
99324-1193
US

V. Phone/Fax

Practice location:
  • Phone: 509-527-2425
  • Fax: 509-527-2426
Mailing address:
  • Phone: 509-527-2425
  • Fax: 509-527-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEN ROGERS
Title or Position: V.P. STUDENT ADMINISTRATION
Credential:
Phone: 509-527-2511