Individual
JASON IMMANUEL BRANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
1956 NE KRESKY AVE, CHEHALIS, WA 98532-2307
(360) 740-4380
Mailing address
PO BOX 59, CHEHALIS, WA 98532-0059
(360) 740-4380
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
61077105
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2161081
—
WA
Enumeration date
07/15/2020
Last updated
02/24/2022
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