Healthcare Provider Details

I. General information

NPI: 1457487274
Provider Name (Legal Business Name): MINNA WONG WURZER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7254
US

IV. Provider business mailing address

PO BOX 1337
VANCOUVER WA
98666-1337
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3085
  • Fax:
Mailing address:
  • Phone: 360-993-3085
  • Fax: 360-993-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60725514
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: