Provider Demographics
NPI:1164039640
Name:PACIFIC PEDIATRIC FEEDING TEAM
Entity type:Organization
Organization Name:PACIFIC PEDIATRIC FEEDING TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:971-236-2831
Mailing Address - Street 1:400 E EVERGREEN BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:971-236-2831
Mailing Address - Fax:360-991-0016
Practice Address - Street 1:400 E EVERGREEN BLVD STE 207
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:971-236-2831
Practice Address - Fax:360-991-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty