1194003590 NPI number — INEZ KATHLEEN RAY-ANNIS, MSW, P.S., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194003590 NPI number — INEZ KATHLEEN RAY-ANNIS, MSW, P.S., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INEZ KATHLEEN RAY-ANNIS, MSW, P.S., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194003590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9330 NE VANCOUVER MALL DRIVE
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-690-6550
Provider Business Mailing Address Fax Number:
360-253-6424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 NE VANCOUVER MALL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-690-6550
Provider Business Practice Location Address Fax Number:
360-253-6424
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RAY-ANNIS
Authorized Official First Name:
INEZ
Authorized Official Middle Name:
KATHLEEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-690-6550

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2003490 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1457482440 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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