Individual
IRENE CRISTINA WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
288 MARTIN ST STE 100, BLAINE, WA 98230-4045
(360) 594-0767
(888) 972-9442
Mailing address
PO BOX 69, BLAINE, WA 98231-0069
(425) 321-1242
(888) 972-9442
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
PSY31119
CA
103TC0700X
Clinical Psychologist
Primary
PY61549569
WA
Other
Enumeration date
05/29/2024
Last updated
10/25/2024
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