Provider Demographics
NPI:1215625355
Name:CLOUD, JANIE ROSE-LOUISE (SUDPT)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:ROSE-LOUISE
Last Name:CLOUD
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 AUTO CENTER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-4388
Mailing Address - Country:US
Mailing Address - Phone:360-373-1529
Mailing Address - Fax:
Practice Address - Street 1:4841 AUTO CENTER WAY STE 101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4388
Practice Address - Country:US
Practice Address - Phone:360-373-1529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61411663101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty