Healthcare Provider Details

I. General information

NPI: 1093630477
Provider Name (Legal Business Name): YAKIMA BRAIN HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 3RD ST STE 105
YAKIMA WA
98901-2827
US

IV. Provider business mailing address

105 S 3RD ST STE 105
YAKIMA WA
98901-2827
US

V. Phone/Fax

Practice location:
  • Phone: 509-731-3191
  • Fax:
Mailing address:
  • Phone: 509-731-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB GROEN
Title or Position: OWNER
Credential: DO
Phone: 206-947-6169