| NPI | 1184019184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE KAY WOLFF Owner 360-560-1972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: WA 603464065) |
| Additional Taxonomies | 261Q00000X (Licence: WA OT00001294) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2020-07-15 |