STACY RAEANN WIRKKALA

KELSO, WA
NPI1144973223
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WA  CO61077791)
Enumeration Date2022-01-30
Last Update Date2023-07-01
Business Address
STACY RAEANN WIRKKALA SUDPT
404 W MAIN ST
KELSO, WA 98626-1118
Phone number: 360-423-2806
Mailing Address
STACY RAEANN WIRKKALA SUDPT
190 GRASSETH POSTON RD
LONGVIEW, WA 98632-9147
Phone number: 360-703-4251
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