Individual
JASON HAUTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
307 W COTA ST, SHELTON, WA 98584-2265
(360) 666-3808
(510) 217-6559
Mailing address
307 W COTA ST, SHELTON, WA 98584-2265
(360) 666-3808
(510) 217-6559
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN00123238
WA
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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