Provider Demographics
NPI:1467523977
Name:VANHORN, VICKI LOIS (MED)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LOIS
Last Name:VANHORN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1673
Mailing Address - Country:US
Mailing Address - Phone:509-751-9165
Mailing Address - Fax:
Practice Address - Street 1:829 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2002
Practice Address - Country:US
Practice Address - Phone:509-758-8011
Practice Address - Fax:509-769-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2744101YP2500X
WA60275894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional