Provider Demographics
NPI:1700693967
Name:BELL, JACQUEITA (CPC, CM)
Entity type:Individual
Prefix:
First Name:JACQUEITA
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:CPC, CM
Other - Prefix:
Other - First Name:JACQUIE
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPC, CM
Mailing Address - Street 1:PO BOX 44836
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98448-0836
Mailing Address - Country:US
Mailing Address - Phone:253-536-4580
Mailing Address - Fax:253-584-2649
Practice Address - Street 1:13718 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-4746
Practice Address - Country:US
Practice Address - Phone:253-536-4580
Practice Address - Fax:253-584-2649
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
WA372600000X, 175T00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No101Y00000XBehavioral Health & Social Service ProvidersCounselor