Healthcare Provider Details

I. General information

NPI: 1679842496
Provider Name (Legal Business Name): REBECCA VELVET SHIMKO CDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 E 1ST ST SUITE #2
PORT ANGELES WA
98362-4020
US

IV. Provider business mailing address

1026 E 1ST ST SUITE #2
PORT ANGELES WA
98362-4020
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-4432
  • Fax: 360-452-4599
Mailing address:
  • Phone: 360-452-4432
  • Fax: 360-452-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60186089
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: