Healthcare Provider Details

I. General information

NPI: 1013495043
Provider Name (Legal Business Name): JOAN MCPHERSON FOREST I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 NE MIDWAY BLVD STE B206A
OAK HARBOR WA
98277-2642
US

IV. Provider business mailing address

2620 DREAMLAND LN
LANGLEY WA
98260-8108
US

V. Phone/Fax

Practice location:
  • Phone: 360-969-5583
  • Fax:
Mailing address:
  • Phone: 360-969-5583
  • Fax: 360-246-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOAN FOREST
Title or Position: OWNER
Credential: LICSW
Phone: 360-969-5583