Individual
SAMANTHA JOANN WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
808 COMMUNITY HALL RD, CUSICK, WA 99119-6034
(509) 447-7193
Mailing address
934 S GARFIELD RD, AIRWAY HEIGHTS, WA 99001-9030
(509) 447-7193
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO60982388
WA
Other
Enumeration date
01/14/2020
Last updated
01/14/2020
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