Provider Demographics
NPI:1033310065
Name:KLICKITAT COUNTY
Entity Type:Organization
Organization Name:KLICKITAT COUNTY
Other - Org Name:VACCINES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR - PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:ERINN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-773-2366
Mailing Address - Street 1:115 W COURT ST
Mailing Address - Street 2:MS-CH BOX# 103
Mailing Address - City:GOLDENDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98620-8905
Mailing Address - Country:US
Mailing Address - Phone:509-773-4565
Mailing Address - Fax:509-773-5991
Practice Address - Street 1:115 W COURT ST
Practice Address - Street 2:ROOM# 103
Practice Address - City:GOLDENDALE
Practice Address - State:WA
Practice Address - Zip Code:98620-8905
Practice Address - Country:US
Practice Address - Phone:503-773-4565
Practice Address - Fax:509-773-5991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLICKITAT COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000956Medicaid
WA1000956Medicaid
WA1011445Medicaid