Healthcare Provider Details

I. General information

NPI: 1750096186
Provider Name (Legal Business Name): RICHELLE RUTH LINCOLN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 1ST AVE N
ILWACO WA
98624-9137
US

IV. Provider business mailing address

152 1ST AVE N
ILWACO WA
98624-9137
US

V. Phone/Fax

Practice location:
  • Phone: 360-261-6930
  • Fax:
Mailing address:
  • Phone: 360-261-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPR70085230
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61399000
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: