Individual
THERESA GWEN BANZET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5001 112TH ST E, TACOMA, WA 98446-5307
(253) 238-7217
Mailing address
5001 112TH ST E, TACOMA, WA 98446-5307
(253) 238-7217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61360518
WA
Other
Enumeration date
11/11/2024
Last updated
12/05/2024
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