Healthcare Provider Details

I. General information

NPI: 1215675970
Provider Name (Legal Business Name): ASHLEY RENAE TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 NE HIGHWAY 99
VANCOUVER WA
98686-5613
US

IV. Provider business mailing address

9300 NE OAK VIEW DR
VANCOUVER WA
98662-6157
US

V. Phone/Fax

Practice location:
  • Phone: 360-644-1631
  • Fax:
Mailing address:
  • Phone: 360-567-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: