Provider Demographics
NPI:1699144733
Name:WINGS SERVICES PLLC
Entity type:Organization
Organization Name:WINGS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MED
Authorized Official - Phone:206-419-3460
Mailing Address - Street 1:1220 N 45TH ST
Mailing Address - Street 2:UNIT 311
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6685
Mailing Address - Country:US
Mailing Address - Phone:206-419-3460
Mailing Address - Fax:
Practice Address - Street 1:16306 EUCLID AVE NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1189
Practice Address - Country:US
Practice Address - Phone:206-419-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1-13-14923251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251S00000XAgenciesCommunity/Behavioral Health