PEACH WILLOW LLC (NPI# 1932608049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932608049 |
| Entity Type | Organization |
| Organization Name | PEACH WILLOW LLC |
| Other Organization Name | PEACH WILLOW SPA |
| Practice Address |
9015 E Mill Plain Blvd Vancouver WA 98664-2536 |
| Practice Telephone | 3607735110 |
| Mailing Telephone | 3607735110 |
| Enumeration Date | 2018-02-03 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | MR. JOHN GOODE (GENERAL MANAGER) |
| Authorized Official Telephone | 3607735110 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 247200000X | Technician, Other | 89329 | WA | Technologists, Technicians & Other Technical Service Providers |
| Other Name | Type Code |
|---|---|
| Peach Willow Spa | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PEACH WILLOW LLC | 9015 E Mill Plain Blvd, Vancouver, WA 98664-2536 |
| Street Address |
9015 E MILL PLAIN BLVD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98664-2536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154921054 | Carolrene Reychelle Jordan | Specialist/Technologist, Other | 9015 E Mill Plain Blvd, Vancouver, WA 98664-2536 | 2020-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249938 | Angelica Maria Parle-fresquez | Speech-Language Pathologist | Early Childhood Assessment Center - Lieser School, 301 S. Lieser Rd, Vancouver, WA 98664 | 2020-09-10 |
| 1467923441 | Elizabeth Steen | Counselor | 230 E. State St., Mossyrock, WA 98664 | 2018-12-17 |
| 1497241657 | Chelsey Nicole Parker | Peer Specialist | 9815 Ne 3rd St, Vancouver, WA 98664 | 2018-07-10 |
| 1881145431 | Brent Homan | Occupational Therapist | 807 Se Morgan Rd., Vancouver, WA 98664 | 2016-10-19 |
| 1114474277 | Rebecca Marie Stefan | Nurse's Aide | 10025 Ne 19th St, Vancouver, WA 98664 | 2016-09-07 |
| 1528454105 | Alicia Ford | Dietitian, Registered | 700 Ne 87th Ave Ste 280, Vancouver, WA 98664 | 2015-04-10 |
| 1033504261 | Reid Roberts Bennett | Anesthesiology | 505 Ne 87th Ave Ste 210, Vancouver, WA 98664 | 2015-04-03 |
| 1235550856 | Nikolay Nikolaevich Chernukhin Jr. | Chiropractor | 221-a Ne 104th Ave, Suite 205, Vancouver, WA 98664 | 2013-12-27 |
| 1013278712 | Serena Harker | Physical Therapy Assistant | 221a Ne 104th Ave, Suite #205, Vancouver, WA 98664 | 2012-05-30 |
| 1295091080 | Rebeca C Johnson | Massage Therapist | 11015 Ne 4th Plain Suite B, Vancouver, WA 98664 | 2012-04-05 |
| Find all providers in zip 98664 | ||||
| Taxonomy Code | 247200000X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Technician, Other |
| A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. |
| Notes: Sources: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988; Dorland’s Illustrated Medical Dictionary, 26th Edition. Philadelphia: W.B. Saunders Company, 1981; and Webster’s II New Riverside University Dictionary. Boston: Riverside Publishing Company, 1984. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376012351 | Jennifer D English | Technician, Other | 9208 Ne Highway 99 Ste 107-78, Vancouver, WA 98665-8986 | 2018-11-19 |
| 1720508906 | Dylan Howell | Technician, Other | 120 Ne 136th Ave Ste 220, Vancouver, WA 98684-6951 | 2017-06-20 |
| 1417428723 | Michael Joseph Thomas | Technician, Other | 6926 Ne Fourth Plain Blvd, Vancouver, WA 98661-7254 | 2018-12-12 |
| 1609354653 | Jeffrey Michael Carse | Technician, Other | 6926 Ne Frth Pln Blvd, Vancouver, WA 98661-7254 | 2018-08-01 |
| 1336663368 | Samantha Morris | Technician, Other | 9901 Ne 7th Ave Ste C116, Vancouver, WA 98685-4528 | 2017-08-01 |
| 1497276943 | Jamila Riley | Technician, Other | 9901 Ne 7th Ave Ste C116, Vancouver, WA 98685-4528 | 2017-07-05 |
| 1598286270 | Kaylee Walker | Technician, Other | 120 Ne 136th Ave Ste 220, Vancouver, WA 98684-6951 | 2017-07-03 |
| 1215457049 | Caleb Masnov | Technician, Other | 9901 Ne 7th Ave Ste C116, Vancouver, WA 98685-4528 | 2017-06-22 |
| 1205356037 | Kyrstina Faulk | Technician, Other | 9901 Ne 7th Ave Ste C116, Vancouver, WA 98685-4528 | 2017-06-22 |
| 1780104513 | Victoria Bergman | Technician, Other | 9901 Ne 7th Ave Ste C116, Vancouver, WA 98685-4528 | 2017-06-22 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.