Basic Information
| Provider Information | |||||||||
| NPI: | 1639701063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOWELL | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | TUYET | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11252 SE BOLTON CT | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970868797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037522095 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16811 SE MCGILLIVRAY BLVD | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986833404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607358100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L7953 | OR | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LW60941478 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.