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1504 S 21st Pl Ridgefield WA 98642-8017 | |
| (360) 727-6558 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1504 S 21st Pl, Ridgefield, Washington |
| Authorized Official Name and Position | Steven R. Conrad (PRESIDENT) |
| Authorized Official Contact | 3607276558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 251 Ridgefield WA 98642-0251 Ph: (360) 727-6558 | 1504 S 21st Pl Ridgefield WA 98642-8017 Ph: (360) 727-6558 |
| NPI Number | 1285011510 |
|---|---|
| Provider Enumeration Date | 05/06/2015 |
| Last Update Date | 05/06/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285011510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CL 60302224 (Washington) | Primary |
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