Provider Demographics
NPI:1174063051
Name:SELKRIDGE, CLAUDETTE V (MC60489858)
Entity type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:V
Last Name:SELKRIDGE
Suffix:
Gender:F
Credentials:MC60489858
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 366
Mailing Address - Street 2:
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548
Mailing Address - Country:US
Mailing Address - Phone:360-285-3400
Mailing Address - Fax:360-930-6887
Practice Address - Street 1:1620 N. OLYMPIC HWY
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-258-3400
Practice Address - Fax:360-930-6887
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60489858101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health