Provider Demographics
NPI:1194937037
Name:CASCADE NEUROLOGIC CLINIC, INC, P.S.
Entity type:Organization
Organization Name:CASCADE NEUROLOGIC CLINIC, INC, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-424-8952
Mailing Address - Street 1:1315 EAST DIVISION ST.
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274
Mailing Address - Country:US
Mailing Address - Phone:360-424-8951
Mailing Address - Fax:360-424-8953
Practice Address - Street 1:1315 EAST DIVISION ST.
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274
Practice Address - Country:US
Practice Address - Phone:360-424-8951
Practice Address - Fax:360-424-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600182628174400000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty