Provider Demographics
NPI:1992824288
Name:VALENZUELA WARD, ELEANOR (CDP)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:VALENZUELA WARD
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18633 DEERFIELD LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9180
Mailing Address - Country:US
Mailing Address - Phone:360-858-1682
Mailing Address - Fax:
Practice Address - Street 1:2708 WESTMOOR CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5754
Practice Address - Country:US
Practice Address - Phone:360-943-8810
Practice Address - Fax:360-943-0931
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVALENEA49806101YA0400X
WACP00001360101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2113288Medicaid
WAVALENEA49806OtherLICENSE