Individual
MRS. KAPRICE M WIDENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
601 CRAWFORD ST, KELSO, WA 98626-4315
(360) 501-1659
Mailing address
601 CRAWFORD ST, KELSO, WA 98626-4315
(360) 501-1659
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL 60323369
WA
Other
Enumeration date
01/17/2013
Last updated
04/15/2014
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