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General NPI Number Information
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NPI Number | 1578933800
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Entity Type | Individual
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Provider Name | CARRIE LEE WIMAN BA
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 9300 NE OAK VIEW DR SUITE B
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City | VANCOUVER
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State | WA
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Zip | 98662-6192
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Country | US
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Telephone | 360-567-2211
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Fax | 360-567-2212
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Provider Business Mailing Address
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Address Line | 18 NE 6TH ST
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City | BATTLE GROUND
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State | WA
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Zip | 98604-8521
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Country | US
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Telephone | 360-921-5730
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Fax | 360-567-2122
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | CG60359429
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License Number State | WA
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