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General NPI Number Information
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NPI Number | 1548750615
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Entity Type | Organization
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Legal Business Name | ONE HEART WILD
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 12620 WILLAMETTE MERIDIAN RD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-9701
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Country | US
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Telephone | 360-509-2948
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Fax | 360-337-7433
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Provider Business Mailing Address
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Address Line | 12620 WILLAMETTE MERIDIAN RD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-9701
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Country | US
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Telephone | 360-509-2948
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Fax | 360-337-7433
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | BRENDA LEE NEWELL
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Credential | LICSW
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Telephone | 425-280-6508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW
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License Number State | WA
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