Provider Demographics
NPI:1083294482
Name:MORRIS, PAULA MARIE (SUDPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:STALCUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2705 NE 59TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-1438
Mailing Address - Country:US
Mailing Address - Phone:360-909-1849
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3713
Practice Address - Country:US
Practice Address - Phone:360-397-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61159609175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist