Provider Demographics
NPI:1497809636
Name:PROGRESS CENTER,INC
Entity Type:Organization
Organization Name:PROGRESS CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORBES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-425-9810
Mailing Address - Street 1:1600 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3231
Mailing Address - Country:US
Mailing Address - Phone:360-425-9810
Mailing Address - Fax:360-425-1053
Practice Address - Street 1:1600 3RD AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3231
Practice Address - Country:US
Practice Address - Phone:360-425-9810
Practice Address - Fax:360-425-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001294174400000X
WAPT00002843174400000X
WAPT00003193174400000X
WALL00003656235Z00000X
WALL00001976235Z00000X
WALL00004192235Z00000X
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7018088Medicaid