Provider Demographics
NPI:1558179291
Name:WINN, TAWNY MICHELLE
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:MICHELLE
Last Name:WINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAWNY
Other - Middle Name:MICHELLE
Other - Last Name:KEZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9221 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-9420
Mailing Address - Country:US
Mailing Address - Phone:509-306-9883
Mailing Address - Fax:
Practice Address - Street 1:120 S 3RD ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2875
Practice Address - Country:US
Practice Address - Phone:509-853-4120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61623928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0755984Medicaid