Healthcare Provider Details

I. General information

NPI: 1396654711
Provider Name (Legal Business Name): BETHANY ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 YAUGER WAY SW
OLYMPIA WA
98502-8660
US

IV. Provider business mailing address

7040 RAPTOR AVE NE
LACEY WA
98516-3149
US

V. Phone/Fax

Practice location:
  • Phone: 360-968-9703
  • Fax:
Mailing address:
  • Phone: 360-584-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: