Healthcare Provider Details

I. General information

NPI: 1003698077
Provider Name (Legal Business Name): JESSICA MORGENTHALER CSWA, LISCWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MAIN ST STE 205
VANCOUVER WA
98663-2235
US

IV. Provider business mailing address

1780 BARNES BLVD SW
TUMWATER WA
98512-0410
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax: 360-326-9691
Mailing address:
  • Phone: 503-563-0565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: