Healthcare Provider Details

I. General information

NPI: 1861953572
Provider Name (Legal Business Name): JEREMY DANIEL HOV MSW, CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD BLDG 18
VANCOUVER WA
98661-3717
US

IV. Provider business mailing address

4210 NE 140TH AVE
VANCOUVER WA
98682-6946
US

V. Phone/Fax

Practice location:
  • Phone: 360-696-4061
  • Fax: 360-905-1738
Mailing address:
  • Phone: 503-810-2733
  • Fax: 360-905-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA5384
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: