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Individual
STACY RAEANN WIRKKALA
Active
Individual
STACY RAEANN WIRKKALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDPT
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61077791
WA
Other
Enumeration date
01/30/2022
Last updated
07/01/2023
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