Healthcare Provider Details

I. General information

NPI: 1316841737
Provider Name (Legal Business Name): MRS. TIFFANIE IRENE NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TIFFANIE IRENE BLANKENSHIP

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ACADEMY ST
KELSO WA
98626-3435
US

IV. Provider business mailing address

2410 GRAND BLVD
VANCOUVER WA
98661-4630
US

V. Phone/Fax

Practice location:
  • Phone: 360-226-7608
  • Fax: 360-226-7608
Mailing address:
  • Phone: 360-226-7608
  • Fax: 360-226-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: