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General NPI Number Information
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NPI Number | 1417301201
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Entity Type | Individual
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Provider Name | ANNA HELENA WAHLSTROM CDP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 9575 ETHAN WADE WAY SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-9577
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Country | US
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Telephone | 425-831-5425
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Fax |
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Provider Business Mailing Address
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Address Line | 10041 394TH PL SE
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City | SNOQUALMIE
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State | WA
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Zip | 98065-9213
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Country | US
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Telephone | 206-407-9104
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP60491075
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License Number State | WA
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