Provider Demographics
NPI:1629843198
Name:GOODWILL OF THE OLYMPIC AND RAINIER REGION
Entity Type:Organization
Organization Name:GOODWILL OF THE OLYMPIC AND RAINIER REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-822-6687
Mailing Address - Street 1:714 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8130
Mailing Address - Country:US
Mailing Address - Phone:253-573-6629
Mailing Address - Fax:
Practice Address - Street 1:714 S 27TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-8130
Practice Address - Country:US
Practice Address - Phone:253-573-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management