Provider Demographics
NPI:1134301450
Name:GUILLEN, MONICA SAMANTHA (MSW)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:SAMANTHA
Last Name:GUILLEN
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 1:7153 VAN BELLE RD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-9763
Mailing Address - Country:US
Mailing Address - Phone:509-830-4300
Mailing Address - Fax:
Practice Address - Street 1:7153 VAN BELLE RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-9763
Practice Address - Country:US
Practice Address - Phone:509-830-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000095371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical