Provider Demographics
NPI:1386152940
Name:HENDRICKS, RAEJEAN (CDPT)
Entity type:Individual
Prefix:
First Name:RAEJEAN
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 NE 80TH CT
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-9576
Mailing Address - Country:US
Mailing Address - Phone:503-381-8098
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD STE 213
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5090
Practice Address - Country:US
Practice Address - Phone:360-750-9635
Practice Address - Fax:360-750-9718
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60806288101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor