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NPI Code Detail

MEDICARE: GINA LILLIE-ANN WAHL CMA

MEDICARE: GINA LILLIE-ANN WAHL CMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorCM60769140WA

General Provider Information

NPI Number : 1699232116
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA LILLIE-ANN WAHL CMA
Provider Business Mailing Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number : 425-349-6100
Fax Number : 425-349-6101
Provider Business Practice Location Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number : 425-349-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2019
Last Update Date : 06/16/2026

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