Healthcare Provider Details

I. General information

NPI: 1205083938
Provider Name (Legal Business Name): JILL FANCHER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 NE 134TH ST STE 340
VANCOUVER WA
98686-3036
US

IV. Provider business mailing address

2621 NE 134TH ST STE 340
VANCOUVER WA
98686-3036
US

V. Phone/Fax

Practice location:
  • Phone: 360-450-0140
  • Fax: 877-343-0535
Mailing address:
  • Phone: 360-450-0140
  • Fax: 877-343-0535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY60103625
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: