Healthcare Provider Details

I. General information

NPI: 1841022738
Provider Name (Legal Business Name): WILLOW WUNSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 MAIN ST STE 100
VANCOUVER WA
98663-2234
US

IV. Provider business mailing address

315 SE 117TH AVE
VANCOUVER WA
98683-5219
US

V. Phone/Fax

Practice location:
  • Phone: 360-693-8064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: