Healthcare Provider Details

I. General information

NPI: 1598669830
Provider Name (Legal Business Name): TANISH JADE MCLEMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANISHA MCLEMORE

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SE STONEMILL DR STE 270
VANCOUVER WA
98684-3509
US

IV. Provider business mailing address

333 NE 136TH AVE APT C79
VANCOUVER WA
98684-6970
US

V. Phone/Fax

Practice location:
  • Phone: 360-622-2253
  • Fax: 833-619-0713
Mailing address:
  • Phone: 541-656-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: