Most Relevant Information
Provider Data
| NPI Number: | 1003382441 |
| Provider Name: | SUSAN GWENDOLYN VISCO |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | CP60010870 |
Most Important Dates
| Enumeration Date: | 10/23/2018 |
| Last Updated: | 10/23/2018 |
Provider Practice Location
3015 TRENTON AVE
BREMERTON
WA
983105347
Practice Location Phone/Fax
| Phone: | 2538584200 |
| Fax: |
Provider Mailing Location
3015 TRENTON AVE
BREMERTON
WA
983105347
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |