Provider Demographics
NPI:1063678548
Name:YASKULKA, JODI (L, M, P)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:YASKULKA
Suffix:
Gender:F
Credentials:L, M, P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 FOURTHPLAIN RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3316
Mailing Address - Country:US
Mailing Address - Phone:360-213-9185
Mailing Address - Fax:
Practice Address - Street 1:10910 FOURTHPLAIN RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-3316
Practice Address - Country:US
Practice Address - Phone:360-213-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist