Provider Demographics
NPI:1699550418
Name:KOMAC, JOLENE QUINN
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:QUINN
Last Name:KOMAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E MAGNOLIA ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4580
Mailing Address - Country:US
Mailing Address - Phone:360-594-1785
Mailing Address - Fax:
Practice Address - Street 1:310 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4580
Practice Address - Country:US
Practice Address - Phone:360-820-5835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician