Healthcare Provider Details

I. General information

NPI: 1568697639
Provider Name (Legal Business Name): WILFREDO DARIO COLLINS M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 NE OAK VIEW DR STE B
VANCOUVER WA
98662-6347
US

IV. Provider business mailing address

9300 NE OAK VIEW DR STE B
VANCOUVER WA
98662-6347
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-2211
  • Fax:
Mailing address:
  • Phone: 360-567-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRC 60081733
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: