MEDICARE: WWU CAMPUS HEALTH & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1629048848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WWU CAMPUS HEALTH & WELLNESS

Provider Business Mailing Address
First Line	:	133 S COLLEGE AVE
Second Line	:	SUITE 101
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1193
Country	:	US
Telephone Number	:	509-527-2425
Fax Number	:	509-527-2426

Provider Business Practice Location Address
First Line	:	133 S COLLEGE AVE
Second Line	:	SUITE 101
City	:	COLLEGE PLACE
State	:	WA
Zip	:	99324-1193
Country	:	US
Telephone Number	:	509-527-2425
Fax Number	:	509-527-2426

Authorized Official
Title or Position	:	V.P. STUDENT ADMINISTRATION
Name	:	MR. KEN ROGERS
Credential	:
Telephone Number	:	509-527-2511

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/27/2007

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Directions to “WWU CAMPUS HEALTH & WELLNESS ” Practice Location

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