Healthcare Provider Details

I. General information

NPI: 1801319827
Provider Name (Legal Business Name): SILOAM PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SE 131ST AVE STE 203
VANCOUVER WA
98683-4013
US

IV. Provider business mailing address

406 SE 131ST AVE STE 203
VANCOUVER WA
98683-4013
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-9580
  • Fax:
Mailing address:
  • Phone: 360-433-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE RENEE JONES
Title or Position: OWNER
Credential: ARNP
Phone: 360-433-9580