Individual
MICHELLE WISE GENDUSA
Active
Individual
MICHELLE WISE GENDUSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22926-C
AR
1041C0700X
Clinical Social Worker
LW60479720
WA
Other
Enumeration date
05/28/2024
Last updated
01/26/2025
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