Provider Demographics
NPI:1578773685
Name:WOTRING, DALE EDWARD (MSW)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWARD
Last Name:WOTRING
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 MAIN ST
Mailing Address - Street 2:SUITE #440
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2999
Mailing Address - Country:US
Mailing Address - Phone:360-694-3040
Mailing Address - Fax:360-735-7484
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:SUITE #440
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2999
Practice Address - Country:US
Practice Address - Phone:360-694-3040
Practice Address - Fax:360-735-7484
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050791041C0700X
ORL08951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical