Provider Demographics
NPI:1023370681
Name:CANFIELD, DIANA LYNN (MSW)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:LYNN
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11117 NE 189TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-6244
Mailing Address - Country:US
Mailing Address - Phone:360-356-5361
Mailing Address - Fax:360-666-7098
Practice Address - Street 1:11117 NE 189TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-6244
Practice Address - Country:US
Practice Address - Phone:360-356-5361
Practice Address - Fax:360-666-7098
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC601642051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical