Provider Demographics
NPI:1073013207
Name:OLIVER, AUDREY (LICSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:HICKOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 S SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1930 S SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3452
Practice Address - Country:US
Practice Address - Phone:253-722-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical