Keli Marie Vasquez, AGENCY AFFILIATED CO

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CG61420119 Issued in WA

Practice address

152 1St Ave N
Ilwaco, WA 98624-9137

Phone

(360) 214-0474

NPI assigned

Apr 3, 2023

Last updated

Jun 4, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717459200000",
    "number": "1043915556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 177",
            "city": "OCEAN PARK",
            "state": "WA",
            "postal_code": "986400177",
            "telephone_number": "360-214-0474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 1ST AVE N",
            "city": "ILWACO",
            "state": "WA",
            "postal_code": "986249137",
            "telephone_number": "360-214-0474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "KELI",
        "middle_name": "MARIE",
        "credential": "AGENCY AFFILIATED CO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-03",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61420119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smart Moves Integrated Health Systems
• William Stoinski, PHARMD
• Thomas Sutherland, RPH
• Lindy Danielle Wood Swain, PHARMD
• Gloria Vandehey, RN-CDE
• Victoria Margaret Vestal, LPTBD
• Mark J Waliser, MD
• Gerald Edward Weaver, MD

• Counselor in Ilwaco, WA
• Providers in Ilwaco, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.