Basic Information
| Provider Information | |||||||||
| NPI: | 1891880167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVISH-PARADISO | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MSW/LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | WALLA WALLA VAMC | ||||||||
| Address2: | 77 WAINWRIGHT DRIVE | ||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
| FaxNumber: | 5095273463 | ||||||||
| Practice Location | |||||||||
| Address1: | WALLA WALLA VAMC | ||||||||
| Address2: | 77 WAINWRIGHT DRIVE | ||||||||
| City: | WALLA WALLA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993623975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095255200 | ||||||||
| FaxNumber: | 5095273463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW00004220 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.