Individual
LA LI
Active
Individual
LA LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW61152108
WA
1041C0700X
Clinical Social Worker
SC60800137
WA
Other
Enumeration date
03/16/2019
Last updated
10/29/2021
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