Organization
CHILD & ADOLESCENT CLINIC, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHYLLIS CAVENS M.D. (PHYSICIAN/OWNER)
(360) 577-1771
Entity
Organization
Contact information
Practice address
971 11TH AVE, LONGVIEW, WA 98632
(360) 577-1771
(360) 423-1405
Mailing address
971 11TH AVE, LONGVIEW, WA 98632-2503
(360) 577-1771
(360) 423-1405
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7066202
—
WA
Enumeration date
05/23/2006
Last updated
07/24/2018
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