Provider Demographics
NPI:1881628055
Name:CHENOWETH, MARCIA SUE (PSYD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:SUE
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:SUE
Other - Last Name:AUCREMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 E 22ND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3266
Mailing Address - Country:US
Mailing Address - Phone:360-696-2744
Mailing Address - Fax:360-696-4811
Practice Address - Street 1:200 E 22ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3266
Practice Address - Country:US
Practice Address - Phone:360-696-2744
Practice Address - Fax:360-696-4811
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003694103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT242213OtherMHN
CT61-49786OtherUNITED BEHAVIORAL HEALTH
CT2072865OtherCIGNA BEHAVIORAL
CT0007701286OtherAETNA
CT213058OtherCOMPSYCH
CT060002290CT04OtherANTHEM BLUE CROSS