Healthcare Provider Details

I. General information

NPI: 1861110108
Provider Name (Legal Business Name): ZHANNA MEDVEDEV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

9700 NE 76TH ST APT 1
VANCOUVER WA
98662-3845
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8246
  • Fax:
Mailing address:
  • Phone: 360-949-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWIA.SC.61564427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: