Healthcare Provider Details

I. General information

NPI: 1235604323
Provider Name (Legal Business Name): RUTH T WOJTOWICZ B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE # 359797
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

325 9TH AVE # 359797
SEATTLE WA
98104-2499
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9636
  • Fax: 206-744-9914
Mailing address:
  • Phone: 206-744-9636
  • Fax: 206-744-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60155930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: