| Wgcn | |
|
1460 Wilmington Dr Dupont WA 98327-8838 | |
| (910) 987-0203 | |
| Not Available |
| Full Name | Wgcn |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1460 Wilmington Dr, Dupont, Washington |
| Authorized Official Name and Position | Stephanie Erin Wilson Gonzalez (NEURODEVELOPMENTAL SYSTEMS DIRECTOR) |
| Authorized Official Contact | 9109870203 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wgcn 930 Ross Loop D325 Dupont WA 98327-9044 Ph: (910) 987-0203 | Wgcn 1460 Wilmington Dr Dupont WA 98327-8838 Ph: (910) 987-0203 |
| NPI Number | 1255799003 |
|---|---|
| Provider Enumeration Date | 02/08/2016 |
| Last Update Date | 02/08/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255799003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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