Individual
LAWRENCE WISSOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 987-0000
Mailing address
4800 SAND POINT WAY NE, SEATTLE, WA 98105-3901
(206) 987-0000
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD60909909
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760428742
—
WA
Enumeration date
06/20/2006
Last updated
02/13/2019
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