Individual
MRS. ANNE M. WISBEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 SOUTH ALDER ST., WALLOWA, OR 97885
(541) 886-3039
(541) 886-3039
Mailing address
P O BOX 5, WALLOWA, OR 97885
(541) 886-3039
(541) 886-3039
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
3111521345
OR
Other
Enumeration date
03/18/2010
Last updated
03/18/2010
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