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General NPI Number Information
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NPI Number | 1720727910
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Entity Type | Organization
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Legal Business Name | VANCOUVER WELLNESS STUDIO, PLLC
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Dates
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Enumeration Date | 06/03/2022
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 800 FRANKLIN ST STE 200
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City | VANCOUVER
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State | WA
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Zip | 98660-3356
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Country | US
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Telephone | 360-828-1429
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Fax |
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Provider Business Mailing Address
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Address Line | 800 FRANKLIN ST STE 200
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City | VANCOUVER
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State | WA
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Zip | 98660-3356
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Country | US
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Telephone | 360-828-1429
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Fax |
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Authorized Official
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Title or Position | MEMBER OWNER
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Name | KENDALL HAGENSEN
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Credential | LMHC
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Telephone | 360-904-9432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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