Provider Demographics
NPI:1891096384
Name:CHANCE, PATRICIA JO (MSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JO
Last Name:CHANCE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 NE 7TH AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4561
Mailing Address - Country:US
Mailing Address - Phone:503-459-6793
Mailing Address - Fax:360-546-1113
Practice Address - Street 1:10000 NE 7TH AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4599
Practice Address - Country:US
Practice Address - Phone:503-459-6793
Practice Address - Fax:360-546-1113
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0840101YM0800X
WALW60203273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0840OtherLICENSE/CLINICAL SOCIAL WORK
WALW60203273OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER