1891096384 NPI number — MS. PATRICIA JO CHANCE MSW

Table of content: MS. PATRICIA JO CHANCE MSW (NPI 1891096384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891096384 NPI number — MS. PATRICIA JO CHANCE MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANCE
Provider First Name:
PATRICIA
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1891096384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10000 NE 7TH AVE STE 325
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98685-4561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-459-6793
Provider Business Mailing Address Fax Number:
360-546-1113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 NE 7TH AVE
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98685-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-459-6793
Provider Business Practice Location Address Fax Number:
360-546-1113
Provider Enumeration Date:
11/15/2010

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: 101YM0800X , with the licence number:  0840 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LW60203273 , 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: 0840 . This is a "LICENSE/CLINICAL SOCIAL WORK" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: LW60203273 . This is a "LICENSED INDEPENDENT CLINICAL SOCIAL WORKER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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