MEDICARE: JENNIFER L SODEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	MD00041217	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073583878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L SODEN MD

Provider Business Mailing Address
First Line	:	505 NE 87TH AVE
Second Line	:	STE 120
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1989
Country	:	US
Telephone Number	:	360-892-1635
Fax Number	:	360-892-3146

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE
Second Line	:	STE 120
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1989
Country	:	US
Telephone Number	:	360-892-1635
Fax Number	:	360-892-3146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/05/2008

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