Healthcare Provider Details

I. General information

NPI: 1396251310
Provider Name (Legal Business Name): MRS. MARLA DEE WHALEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLA DEE SOWERS CDP

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 INGRAM ST
HOQUIAM WA
98550-4410
US

IV. Provider business mailing address

3033 INGRAM ST
HOQUIAM WA
98550-4410
US

V. Phone/Fax

Practice location:
  • Phone: 360-999-7429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: