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General NPI Number Information
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NPI Number | 1043408024
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Entity Type | Individual
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Provider Name | CHRISTINE WUNG PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 2485 12TH ST SE WVP BOULDER CREEK
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City | SALEM
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State | OR
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Zip | 97302
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Country | US
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Telephone | 503-967-1411
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4025
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City | SALEM
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State | OR
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Zip | 97302-1025
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Country | US
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Telephone | 503-269-6330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1923
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License Number State | OR
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