Individual
JEANIE NICOLE WADIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDPT, MHCA
Contact information
Practice address
2924 FALK RD, VANCOUVER, WA 98661-5604
(360) 750-9588
(360) 750-9718
Mailing address
31208 NE 59TH AVE, LA CENTER, WA 98629-2304
(360) 750-9588
(360) 750-9718
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CO60404199
WA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60532732
WA
101YM0800X
Mental Health Counselor
MC60521887
WA
Other
Enumeration date
09/29/2016
Last updated
09/29/2016
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