Individual
AMBER FAWN GENTRYSOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.W, LICSW
Contact information
Practice address
325 E PIONEER, PUYALLUP, WA 98372-3265
(253) 445-8120
(253) 697-3730
Mailing address
325 E PIONEER, PUYALLUP, WA 98372-3265
(253) 445-8120
(253) 697-3730
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LW 60072190
WA
Other
Enumeration date
04/10/2008
Last updated
04/26/2012
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