Individual
NORMAN GUSTAVSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
9340 NE 76TH ST, VANCOUVER, WA 98662-3721
(360) 253-4912
Mailing address
9340 NE 76TH ST, VANCOUVER, WA 98662-3721
(360) 253-4912
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
01372
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01372
LICENSE AS A CLINICAL PSYCHOLOGIST
WA
Enumeration date
03/20/2015
Last updated
03/20/2015
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