Provider Demographics
NPI:1942201637
Name:POLLASTRO, CHRISTINE JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:JEAN
Last Name:POLLASTRO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 BROADWAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3390
Mailing Address - Country:US
Mailing Address - Phone:509-432-3084
Mailing Address - Fax:
Practice Address - Street 1:2900 NW 106TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-4734
Practice Address - Country:US
Practice Address - Phone:509-432-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011106Medicaid
911383928OtherFED TAX ID
911635333OtherFEDERAL TAX ID
911383928OtherFED TAX ID
WAG8895929Medicare PIN