Individual
VIVIAN HAGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
508 SE 117TH AVE, VANCOUVER, WA 98683-5268
(360) 254-1424
Mailing address
508 SE 117TH AVE, VANCOUVER, WA 98683-5268
(360) 254-1424
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
WA
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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