Individual
JUSTINE MARIE IVY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
2641 242ND PL SE, BOTHELL, WA 98021-6508
(206) 229-4056
Mailing address
2641 242ND PL SE, BOTHELL, WA 98021-6508
(206) 229-4056
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW60334018
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LW60334018
WA LICSW PROVIDER NUMBER
WA
Enumeration date
10/14/2019
Last updated
10/14/2019
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