Provider Demographics
NPI:1316371859
Name:GONZALES, DAYLEN L (MSW)
Entity Type:Individual
Prefix:
First Name:DAYLEN
Middle Name:L
Last Name:GONZALES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:PMB 9773
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0257
Mailing Address - Country:US
Mailing Address - Phone:253-220-7230
Mailing Address - Fax:
Practice Address - Street 1:727 N TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4754
Practice Address - Country:US
Practice Address - Phone:360-764-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-01
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60818881101YA0400X
WALW610905271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)