| Iredale Professional Services | |
|
1804 Se 170th Ave Vancouver WA 98683-3474 | |
| (360) 991-0134 | |
| (360) 991-0154 |
| Full Name | Iredale Professional Services |
|---|---|
| Speciality | Psychologist |
| Location | 1804 Se 170th Ave, Vancouver, Washington |
| Authorized Official Name and Position | Trudy A Iredale (OWNER/PSYCHOLOGIST) |
| Authorized Official Contact | 3609910134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Iredale Professional Services 1804 Se 170th Ave Vancouver WA 98683-3474 Ph: (360) 991-0134 | Iredale Professional Services 1804 Se 170th Ave Vancouver WA 98683-3474 Ph: (360) 991-0134 |
| NPI Number | 1841811783 |
|---|---|
| Provider Enumeration Date | 05/01/2020 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 8628494424 |
|---|---|
| Medicare Enrollment ID | O20200811001886 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841811783 | NPI | - | NPPES |
| 1841811783 | Other | TYPE II NPI | |
| 1770649402 | Other | NPI | |
| PY00003097 | Other | WA | WA STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Trudy A Iredale |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770649402 PECOS PAC ID: 9931280583 Enrollment ID: I20080121000337 |
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