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General NPI Number Information
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NPI Number | 1659181790
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Entity Type | Organization
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Legal Business Name | NW REENTRY SERVICES, LLC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | PO BOX 73217
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City | PUYALLUP
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State | WA
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Zip | 98373-0217
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Country | US
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Telephone | 253-271-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 18208 113TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98374-8854
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Country | US
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Telephone | 253-359-3219
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXA BALDERSTON
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Credential |
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Telephone | 532-718-8812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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