Jeanie Nicole Wadiak, CDPT, MHCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP60532732 Issued in WA

Practice address

2924 Falk Rd
Vancouver, WA 98661-5604

Phone

(360) 750-9588

Fax

(360) 750-9718

NPI assigned

Sep 29, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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": "1475107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475107200000",
    "number": "1629527718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31208 NE 59TH AVE",
            "city": "LA CENTER",
            "state": "WA",
            "postal_code": "986292304",
            "telephone_number": "360-750-9588",
            "fax_number": "360-750-9718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2924 FALK RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986615604",
            "telephone_number": "360-750-9588",
            "fax_number": "360-750-9718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADIAK",
        "first_name": "JEANIE",
        "middle_name": "NICOLE",
        "credential": "CDPT, MHCA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-29",
        "last_updated": "2016-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60532732",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60404199",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60521887",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Edwin Wachenheim, MD
• Paul Daniel Waddington
• Sally Marie Waddle, PA-C
• Andrew Wade, DC
• Nicole Kathleen Wade, RN
• Matthew E. Wadzita
• Pamela Wadzita, M. ED. LMHC
• Jeanie Wagener, MS, CCC
• Andromyda Wagenman
• Shawn Michelle Wager, L.P.N.

• Addiction (Substance Use Disorder) Counselor in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.