Healthcare Provider Details

I. General information

NPI: 1336061811
Provider Name (Legal Business Name): MS. KASEY JO WESTOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4701 NE 77TH AVE APT I35
VANCOUVER WA
98662-7903
US

IV. Provider business mailing address

4701 NE 77TH AVE APT I35
VANCOUVER WA
98662-7903
US

V. Phone/Fax

Practice location:
  • Phone: 503-583-3735
  • Fax:
Mailing address:
  • Phone: 503-583-3735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: