Provider Demographics
NPI:1093120743
Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:WASHINGTON STATE DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TEBALDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-236-4204
Mailing Address - Street 1:PO BOX 47841
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-7841
Mailing Address - Country:US
Mailing Address - Phone:360-236-3479
Mailing Address - Fax:360-664-2216
Practice Address - Street 1:310 ISRAEL RD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5567
Practice Address - Country:US
Practice Address - Phone:360-236-3479
Practice Address - Fax:360-664-2216
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON STATE DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare