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General NPI Number Information
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NPI Number | 1083572887
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Entity Type | Individual
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Provider Name | WALLACE FORSLOF
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Gender | Male
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 16300 MILL CREEK BLVD
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City | MILL CREEK
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State | WA
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Zip | 98012-1737
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Country | US
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Telephone | 206-618-0770
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Fax |
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Provider Business Mailing Address
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Address Line | 20318 36TH AVE NW
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City | STANWOOD
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State | WA
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Zip | 98292-9018
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Country | US
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Telephone | 206-618-0770
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MHCA.MC.70001246
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License Number State | WA
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