MEDICARE: MS. EVELYN MEYER CDS II, CDP

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	060745	WA

General Provider Information

NPI Number	:	1134306798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EVELYN MEYER CDS II, CDP

Provider Business Mailing Address
First Line	:	111 W 39TH ST STE A
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98660-1974
Country	:	US
Telephone Number	:	360-696-1023
Fax Number	:	360-696-0067

Provider Business Practice Location Address
First Line	:	111 W 39TH ST STE A
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98660-1974
Country	:	US
Telephone Number	:	360-696-1023
Fax Number	:	360-696-0067

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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