Provider Demographics
NPI:1063175644
Name:CASCADE CLINIC
Entity type:Organization
Organization Name:CASCADE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC SLP
Authorized Official - Phone:360-230-8557
Mailing Address - Street 1:1220 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2963
Mailing Address - Country:US
Mailing Address - Phone:360-230-8557
Mailing Address - Fax:888-915-0898
Practice Address - Street 1:1220 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2963
Practice Address - Country:US
Practice Address - Phone:360-230-8557
Practice Address - Fax:888-915-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QA3000XAmbulatory Health Care FacilitiesClinic/CenterAugmentative CommunicationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1063175644OtherREGENCE BCBS
WA1346591153Medicaid
1063175644OtherMODA
1063175644OtherUNITED HEALTH CARE
WA1063175644OtherPREMERA
WA1063175644OtherCIGNA
WA1063175644OtherKAISER
WA1063175644OtherAETNA
1063175644OtherREGENCE
WA1063175644OtherPACIFIC SOURCE
WA1063175644Medicaid
WA1063175644OtherTRICARE WEST
WA1346591153OtherTRICARE WEST
OR1346591153OtherREGENCE BCBS