Healthcare Provider Details

I. General information

NPI: 1518541663
Provider Name (Legal Business Name): JONATHON A HEW LEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 WOODLAND SQUARE LOOP SE STE 401
LACEY WA
98503-1070
US

IV. Provider business mailing address

612 WOODLAND SQUARE LOOP SE STE 401
LACEY WA
98503-1070
US

V. Phone/Fax

Practice location:
  • Phone: 360-763-5828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60716084
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: