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General NPI Number Information
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NPI Number | 1164039640
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Entity Type | Organization
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Legal Business Name | PACIFIC PEDIATRIC FEEDING TEAM
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 400 E EVERGREEN BLVD STE 207
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City | VANCOUVER
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State | WA
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Zip | 98660-3264
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Country | US
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Telephone | 971-236-2831
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Fax | 360-991-0016
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Provider Business Mailing Address
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Address Line | 400 E EVERGREEN BLVD STE 207
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City | VANCOUVER
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State | WA
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Zip | 98660-3264
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Country | US
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Telephone | 971-236-2831
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Fax | 360-991-0016
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST, OWNER
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Name | JOANNA RASMUSSEN
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Credential | SLP
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Telephone | 971-236-2831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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