Provider Demographics
NPI:1376530584
Name:PAQUETTE, SIMON B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:B
Last Name:PAQUETTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18608 SE 36TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8244
Mailing Address - Country:US
Mailing Address - Phone:360-903-4385
Mailing Address - Fax:360-449-0009
Practice Address - Street 1:18608 SE 36TH CIR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8244
Practice Address - Country:US
Practice Address - Phone:360-903-4385
Practice Address - Fax:360-449-0009
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26501041C0700X
WALW 600419171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60041917OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER