Provider Demographics
NPI:1336552488
Name:HAMILTON, JONI MARIE (CDP)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:MARIE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:MS
Other - First Name:JONI
Other - Middle Name:MARIE
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDP
Mailing Address - Street 1:2308 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3617
Mailing Address - Country:US
Mailing Address - Phone:360-540-3483
Mailing Address - Fax:
Practice Address - Street 1:6750 MISSION RD
Practice Address - Street 2:
Practice Address - City:EVERSON
Practice Address - State:WA
Practice Address - Zip Code:98247-9749
Practice Address - Country:US
Practice Address - Phone:360-966-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 00003178171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37023000Medicaid