Healthcare Provider Details

I. General information

NPI: 1962043356
Provider Name (Legal Business Name): JOLEANNE WEST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 NE 13TH AVE
VANCOUVER WA
98665-9604
US

IV. Provider business mailing address

8019 NE 13TH AVE
VANCOUVER WA
98665-9604
US

V. Phone/Fax

Practice location:
  • Phone: 360-984-3131
  • Fax: 360-718-8542
Mailing address:
  • Phone: 360-984-3131
  • Fax: 360-718-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberCB60963166
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: