Provider Demographics
NPI:1417170820
Name:FAMILY PLANNING OF CLALLAM COUNTY
Entity Type:Organization
Organization Name:FAMILY PLANNING OF CLALLAM COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-452-2954
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0160
Mailing Address - Country:US
Mailing Address - Phone:360-452-2954
Mailing Address - Fax:360-457-7683
Practice Address - Street 1:140 C ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9024
Practice Address - Country:US
Practice Address - Phone:360-374-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600258997000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7921109Medicaid
WAAB39834Medicare ID - Type Unspecified