| NPI | 1447207287 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI KETTLER Provider Enrollment Lead 360-729-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 208000000X Pediatrics | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 208600000X Surgery | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 106H00000X Marriage & Family Therapist | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 133V00000X Dietitian, Registered | |
| 367A00000X Advanced Practice Midwife | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2017-04-04 |