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General NPI Number Information
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NPI Number | 1164377008
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Entity Type | Individual
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Provider Name | MARISSA CORIE WYNHOFF CPSS
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Gender | Female
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 115 S GOLDEN ST
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City | GOLDENDALE
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State | WA
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Zip | 98620-9123
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Country | US
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Telephone | 509-773-2419
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Fax | 509-973-5921
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Provider Business Mailing Address
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Address Line | PO BOX 1228
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City | GOLDENDALE
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State | WA
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Zip | 98620-1228
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Country | US
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Telephone | 509-773-2419
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Fax | 509-973-5921
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PR70077350
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License Number State | WA
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