Provider Demographics
NPI:1407803786
Name:HALLIE CONDIT, LICSW
Entity Type:Organization
Organization Name:HALLIE CONDIT, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:HALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDIT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:425-462-2799
Mailing Address - Street 1:18233 29TH PL NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4156
Mailing Address - Country:US
Mailing Address - Phone:425-462-2799
Mailing Address - Fax:206-367-1001
Practice Address - Street 1:11415 NE 128TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-462-2799
Practice Address - Fax:206-367-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000053491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty