Physician Compare National (NPI:1720350960)

HEALTHCARE PROVIDER: CHARLES WAYLAND LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720350960
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163728627
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160309000668
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAYLAND
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	336 W SPRUCE ST
	Group Practice or individual's line 1 address
City	MISSOULA
	Group Practice or individual's city
State	MT
	Group Practice or individual's state
Zip Code	598024108
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4063967834
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y