| Organization Name: | THE WILSON GONZALEZ CENTER FOR NEUROEDUCATION AND STUDENT DRIVEN LEARN |
| NPI Number: | 1255799003 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHANIE ERIN WILSON GONZALEZ (NEURODEVELOPMENTAL SYSTEMS DIRECTOR) |
| Mailing Address: | 1460 Wilmington Dr Dupont |
| State: | WA US |
| Postal Code: | 983278838 |
| Phone Number: | 9109870203 |
| Fax Number: | |
| NPI Enumeration Date: | 02/08/2016 |
| NPI Last Update Date: | 02/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |