Provider Demographics
NPI:1285919332
Name:MASTOR, GINGER M (MSW)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:M
Last Name:MASTOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1317
Mailing Address - Country:US
Mailing Address - Phone:509-382-1164
Mailing Address - Fax:509-382-1166
Practice Address - Street 1:221 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1317
Practice Address - Country:US
Practice Address - Phone:509-382-1164
Practice Address - Fax:509-382-1166
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60117501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker