Provider Demographics
NPI:1609408640
Name:WASHBURN, RANDA NICOLE
Entity Type:Individual
Prefix:
First Name:RANDA
Middle Name:NICOLE
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:
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 354
Mailing Address - Street 2:
Mailing Address - City:BUENA
Mailing Address - State:WA
Mailing Address - Zip Code:98921-0354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:BUENA
Practice Address - State:WA
Practice Address - Zip Code:98921-0139
Practice Address - Country:US
Practice Address - Phone:509-865-6705
Practice Address - Fax:509-865-5011
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0755984Medicaid