Individual
MS. AUTUMN R FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1003 7TH AVE, KIRKLAND, WA 98033-5779
(425) 658-3016
Mailing address
1003 7TH AVE, KIRKLAND, WA 98033-5779
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34012088A
IN
106S00000X
Behavior Technician
—
—
Other
Enumeration date
10/14/2019
Last updated
10/30/2025
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