Provider Demographics
NPI:1114462645
Name:PAULENICH, ARIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:
Last Name:PAULENICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3134
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-3134
Mailing Address - Country:US
Mailing Address - Phone:360-296-3989
Mailing Address - Fax:
Practice Address - Street 1:2413 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8827
Practice Address - Country:US
Practice Address - Phone:360-296-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60616293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical