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Individual

GREGORY L. WILTFANG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD, LISW

Contact information

Practice address
139 S 2ND ST, SUITE 4, RATON, NM 87740-3905
(575) 445-2250
(157) 544-5054
Mailing address
P.O. BOX 566, 139 S 2ND ST, RATON, NM 87740-3905
(575) 445-2250
(157) 544-5054

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-07762
NM
1041C0700X
Clinical Social Worker
M-67045
NM

Other

Enumeration date
08/28/2009
Last updated
11/21/2011
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