Healthcare Provider Details

I. General information

NPI: 1770721870
Provider Name (Legal Business Name): LANDON EUGENE POPPLETON PHD, JD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 NE 87TH AVE
VANCOUVER WA
98664-1915
US

IV. Provider business mailing address

814 NE 87TH AVE
VANCOUVER WA
98664-1915
US

V. Phone/Fax

Practice location:
  • Phone: 360-910-1522
  • Fax: 360-326-1522
Mailing address:
  • Phone: 360-910-1522
  • Fax: 360-326-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY 60041144
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 60041144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: