=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033310065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLICKITAT COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 02/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 W COURT ST ROOM# 103
-----------------------------------------------------
City | GOLDENDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98620-8905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-773-4565
-----------------------------------------------------
Fax | 509-773-5991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 W COURT ST MS-CH BOX# 103
-----------------------------------------------------
City | GOLDENDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98620-8905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-773-4565
-----------------------------------------------------
Fax | 509-773-5991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR - PUBLIC HEALTH
-----------------------------------------------------
Name | ERINN QUINN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 509-773-2366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------