Healthcare Provider Details

I. General information

NPI: 1003118589
Provider Name (Legal Business Name): JEDADIAH ESLINGER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E ROSE ST
WALLA WALLA WA
99362-5009
US

IV. Provider business mailing address

663 CARDINAL DR
WALLA WALLA WA
99362-1507
US

V. Phone/Fax

Practice location:
  • Phone: 509-540-9621
  • Fax:
Mailing address:
  • Phone: 509-540-9621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60711972
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: