Provider Demographics
NPI:1205671831
Name:WIXSON, GAILON SUMMER (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:GAILON
Middle Name:SUMMER
Last Name:WIXSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 CALIFORNIA AVE SW APT 303
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-1669
Mailing Address - Country:US
Mailing Address - Phone:360-250-0098
Mailing Address - Fax:
Practice Address - Street 1:5941 CALIFORNIA AVE SW APT 303
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1669
Practice Address - Country:US
Practice Address - Phone:360-250-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW612039261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical