Provider Demographics
NPI:1679842496
Name:SHIMKO, REBECCA VELVET (CDPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:VELVET
Last Name:SHIMKO
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 E 1ST ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4020
Mailing Address - Country:US
Mailing Address - Phone:360-452-4432
Mailing Address - Fax:360-452-4599
Practice Address - Street 1:1026 E 1ST ST
Practice Address - Street 2:SUITE #2
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4020
Practice Address - Country:US
Practice Address - Phone:360-452-4432
Practice Address - Fax:360-452-4599
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60186089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)