Healthcare Provider Details

I. General information

NPI: 1063175644
Provider Name (Legal Business Name): CASCADE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAIN ST STE 400
VANCOUVER WA
98660-2963
US

IV. Provider business mailing address

1220 MAIN ST STE 400
VANCOUVER WA
98660-2963
US

V. Phone/Fax

Practice location:
  • Phone: 360-230-8557
  • Fax: 888-915-0898
Mailing address:
  • Phone: 360-230-8557
  • Fax: 888-915-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KARRIE J PETERSEN
Title or Position: OWNER/PROVIDER
Credential: CCC SLP
Phone: 360-230-8557