Healthcare Provider Details

I. General information

NPI: 1700693967
Provider Name (Legal Business Name): JACQUEITA BELL CPC, CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUIE BELL CPC, CM

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13718 PACIFIC AVE S
TACOMA WA
98444-4746
US

IV. Provider business mailing address

PO BOX 44836
TACOMA WA
98448-0836
US

V. Phone/Fax

Practice location:
  • Phone: 253-536-4580
  • Fax: 253-584-2649
Mailing address:
  • Phone: 253-536-4580
  • Fax: 253-584-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: