Child and Adolescent Clinic
NPI #1134657778 in Longview, Washington
Provider Information
- NPI Number
- 1134657778
- Entity Type
- Organization
- Organization Name
- Child and Adolescent Clinic
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- CHILD AND ADOLESCENT CLINIC
- Primary Specialty
- Case Manager/Care Coordinator
- Enumeration Date
- May 26, 2017
- Last Updated
- May 26, 2017
Practice Location
- Address
- 971 11TH AVE
- City
- Longview
- State
- Washington
- ZIP Code
- 98632-2503
- Phone
- (360) 577-1771
Authorized Official
- Name
- CHELSAY PEDERSEN
- Title
- CREDENTIALING SPECIALIST
- Phone
- (360) 423-6140
Specialties & Taxonomy Codes
| Specialty |
|---|
| Case Manager/Care Coordinator |
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