Healthcare Provider Details

I. General information

NPI: 1699247742
Provider Name (Legal Business Name): JACOB ALBERT LINDER CDPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 IRVING ST SW STE 301
TUMWATER WA
98512-6362
US

IV. Provider business mailing address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-5766
  • Fax: 509-242-1867
Mailing address:
  • Phone: 509-232-5766
  • Fax: 509-321-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCO60818831
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: