Provider Demographics
NPI:1184611477
Name:SANDWICK, GARY R (MA)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:SANDWICK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 12TH CT SW
Mailing Address - Street 2:SUITE B5
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1022
Mailing Address - Country:US
Mailing Address - Phone:360-493-1700
Mailing Address - Fax:360-352-7881
Practice Address - Street 1:2617 12TH CT SW
Practice Address - Street 2:SUITE B5
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1022
Practice Address - Country:US
Practice Address - Phone:360-493-1700
Practice Address - Fax:360-352-7881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004858101YM0800X
WALF00000852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist