Individual
RAVON WILCZEWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
150 S MAIN ST, LAKEPORT, CA 95453-5017
(707) 994-5486
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/13/2024
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