Healthcare Provider Details

I. General information

NPI: 1497809636
Provider Name (Legal Business Name): PROGRESS CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 3RD AVE
LONGVIEW WA
98632-3231
US

IV. Provider business mailing address

1600 3RD AVE
LONGVIEW WA
98632-3231
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-9810
  • Fax: 360-425-1053
Mailing address:
  • Phone: 360-425-9810
  • Fax: 360-425-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT00001294
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT00002843
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT00003193
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00003656
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00001976
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004192
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateWA

VIII. Authorized Official

Name: ROBIN L FORBES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-425-9810