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General NPI Number Information
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NPI Number | 1457532913
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Entity Type | Organization
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Legal Business Name | FRONT STREET CLINIC INC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 20174 FRONT ST NE
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City | POULSBO
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State | WA
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Zip | 98370-7445
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Country | US
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Telephone | 360-697-1141
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Fax | 360-697-2395
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Provider Business Mailing Address
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Address Line | PO BOX 1611
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City | POULSBO
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State | WA
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Zip | 98370-0197
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Country | US
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Telephone | 360-697-1141
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Fax | 360-697-2395
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | OLGA A POPACH
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Credential | MANAGER
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Telephone | 360-697-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY00000965
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License Number State | WA
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