1881628055 NPI number — MARCIA SUE CHENOWETH PSYD

Table of content: (NPI 1346893799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881628055 NPI number — MARCIA SUE CHENOWETH PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHENOWETH
Provider First Name:
MARCIA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AUCREMAN
Provider Other First Name:
MARCIA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881628055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E 22ND ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98663-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-696-2744
Provider Business Mailing Address Fax Number:
360-696-4811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E 22ND ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663-3266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-696-2744
Provider Business Practice Location Address Fax Number:
360-696-4811
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY00003694 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 242213 . This is a "MHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 61-49786 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2072865 . This is a "CIGNA BEHAVIORAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0007701286 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 213058 . This is a "COMPSYCH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 060002290CT04 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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