Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | CG 60497820 | WA |
NPI | 1003217589 |
---|---|
Provider Name | Rebecca Stoker |
First Address | Puyallup, WA 98372-3265 |
Second Address | Puyallup, WA 98372-3265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2014 |
Last Update Date | 15/09/2014 |