Individual
DR. MARA CATHERINE GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
10625 DIXON DR S, SEATTLE, WA 98178-2718
(847) 827-0700
Mailing address
10625 DIXON DR S, SEATTLE, WA 98178-2718
(206) 929-0492
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY61031462
WA
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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