Healthcare Provider Details

I. General information

NPI: 1508772757
Provider Name (Legal Business Name): CHERYL VANCLEEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21810 NE 37TH AVE
RIDGEFIELD WA
98642-7747
US

IV. Provider business mailing address

7 W PINE LN
LONGVIEW WA
98632-5189
US

V. Phone/Fax

Practice location:
  • Phone: 360-687-8555
  • Fax:
Mailing address:
  • Phone: 360-751-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.61593042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: