Provider Demographics
NPI:1679316913
Name:AREVALO, RAINEE ANN
Entity type:Individual
Prefix:
First Name:RAINEE
Middle Name:ANN
Last Name:AREVALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAINEE
Other - Middle Name:A
Other - Last Name:BAYLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 LAST CHANCE RD
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-8292
Mailing Address - Country:US
Mailing Address - Phone:509-301-5813
Mailing Address - Fax:
Practice Address - Street 1:116 LAST CHANCE RD
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8292
Practice Address - Country:US
Practice Address - Phone:509-301-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical