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Individual

JEB BOLERJACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
784 14TH AVE, LONGVIEW, WA 98632-2315
(360) 703-6400
(360) 353-3611
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 636-3892
(360) 414-1342

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP00005027
WA
163W00000X
Registered Nurse
Primary
RN60344179
WA

Other

Enumeration date
04/25/2018
Last updated
06/27/2019
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