Provider Demographics
NPI:1467986430
Name:PAUL REPPAS PHD PLLC
Entity Type:Organization
Organization Name:PAUL REPPAS PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:REPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-885-9045
Mailing Address - Street 1:23 S WENATCHEE AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2264
Mailing Address - Country:US
Mailing Address - Phone:509-885-9045
Mailing Address - Fax:509-885-9045
Practice Address - Street 1:23 S WENATCHEE AVE
Practice Address - Street 2:STE 202
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2264
Practice Address - Country:US
Practice Address - Phone:509-885-9045
Practice Address - Fax:509-885-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60711473103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077655Medicaid