=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760684823
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. SHARON ANNE SOLLENBERGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2007
-----------------------------------------------------
Last Update Date | 01/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9300 NE OAK VIEW DR SUITE B
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-567-2211
-----------------------------------------------------
Fax | 360-567-2212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6306 NE 87TH AVE
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-5492
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-823-7918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CG60184913
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------