Provider Demographics
NPI:1467768333
Name:WYSS, PAMELA ANNE (LICSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNE
Last Name:WYSS
Suffix:
Gender:F
Credentials:LICSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 192ND ST SE
Mailing Address - Street 2:W-201
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7937
Mailing Address - Country:US
Mailing Address - Phone:425-239-2563
Mailing Address - Fax:425-488-7908
Practice Address - Street 1:2201 192ND ST SE
Practice Address - Street 2:W-201
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-7937
Practice Address - Country:US
Practice Address - Phone:425-239-2563
Practice Address - Fax:425-488-7908
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000052171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical