Individual
SUELLEN MITZNER WILLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2576 NEW HOPE RD, GRANTS PASS, OR 97527-9027
(541) 479-1544
Mailing address
2576 NEW HOPE RD, GRANTS PASS, OR 97527-9027
(541) 479-1544
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
002511
OR
Other
Enumeration date
04/27/2010
Last updated
04/27/2010
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