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Individual
MR. THOMAS GWYNNE WALES
Active
Individual
MR. THOMAS GWYNNE WALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14061
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090H8WA
BLUE CROSS BLUE SHIELD OF MINNESOTA CLINIC ID
MN
05
—
444260100
—
MN
Enumeration date
06/17/2008
Last updated
06/18/2013
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