Provider Demographics
NPI:1699661116
Name:PRATT, WILFRED
Entity type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:PRATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5527
Mailing Address - Country:US
Mailing Address - Phone:703-415-8977
Mailing Address - Fax:
Practice Address - Street 1:5420 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5527
Practice Address - Country:US
Practice Address - Phone:703-415-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator