Basic Information
Provider Information
NPI: 1598259475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALDRICH
FirstName: REBECCA
MiddleName: JEAN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1014 WALLA WALLA AVE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988011523
CountryCode: US
TelephoneNumber: 5096630034
FaxNumber: 5096633726
Practice Location
Address1: 1014 WALLA WALLA AVE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988011523
CountryCode: US
TelephoneNumber: 5096630034
FaxNumber: 5096633726
Other Information
ProviderEnumerationDate: 06/14/2018
LastUpdateDate: 12/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XCG60821185WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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