| Doctor Name: | RAVEN L.E. JIRIKOVIC |
| NPI Number: | 1447343942 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RC00029629 |
| Business Practice Address: | 105 Nw 1st St. Coupeville, WA - 98239 |
| Business Phone Number: | 3606824052 |
| Business Fax Number: | 3606783636 |
| Mailing Address: | 3785 E. Midvale Rd., CLINTON |
| State: | WA |
| Postal Code: | 98236 |
| Phone Number: | 8888412281 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | RC00029629 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |