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General NPI Number Information
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NPI Number | 1134480809
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Entity Type | Organization
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Legal Business Name | VETERANS AFFAIRS
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 9600 VETERANS DR.
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City | TACOMA
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State | WA
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Zip | 98498
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Country | US
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Telephone | 253-583-1767
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 VETERANS DR.
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City | TACOMA
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State | WA
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Zip | 98498
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Country | US
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Telephone | 253-583-1767
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. JONATHAN WILLIAM WICKS
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Credential | MSW
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Telephone | 253-583-1767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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