Provider Demographics
NPI:1841225208
Name:COUNTY OF JEFFERSON
Entity Type:Organization
Organization Name:COUNTY OF JEFFERSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-385-9400
Mailing Address - Street 1:615 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2439
Mailing Address - Country:US
Mailing Address - Phone:360-385-9400
Mailing Address - Fax:360-385-9401
Practice Address - Street 1:615 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2439
Practice Address - Country:US
Practice Address - Phone:360-385-9400
Practice Address - Fax:360-385-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1521400Medicaid
WA7311707Medicaid
WA7311707Medicaid
WA1521400Medicaid