Provider Demographics
| NPI: | 1730371204 |
|---|---|
| Name: | KLICKITAT COUNTY |
| Entity type: | Organization |
| Organization Name: | KLICKITAT COUNTY |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR - HEALTH DEPARTMENT & BH |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ERINN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | QUINN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | RN |
| Authorized Official - Phone: | 509-773-2366 |
| Mailing Address - Street 1: | 115 W COURT ST |
| Mailing Address - Street 2: | MS-CH - BOX# 103 |
| Mailing Address - City: | GOLDENDALE |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 98620-8905 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 509-773-4565 |
| Mailing Address - Fax: | 509-773-5991 |
| Practice Address - Street 1: | 115 W COURT ST |
| Practice Address - Street 2: | ROOM# 103 |
| Practice Address - City: | GOLDENDALE |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 98620-8905 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 509-773-4565 |
| Practice Address - Fax: | 509-773-5991 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | KLICKITAT COUNTY HEALTH DEPARTMENT |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-08-17 |
| Last Update Date: | 2024-02-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251K00000X | Agencies | Public Health or Welfare | ||
| No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
| No | 261QF0050X | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | ||
| Yes | 261QA0005X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility | |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
| No | 261QP0905X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | |
| No | 364SC1501X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health | Group - Multi-Specialty |
| No | 364SF0001X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | Group - Multi-Specialty |
| No | 364SW0102X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Women's Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WA | 1017722 | Medicaid | |
| WA | 1017722 | Medicaid | |
| WA | 1000956 | Medicaid |
