Provider Demographics
NPI:1407951742
Name:WERKHOVEN, WALTER SAM (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:SAM
Last Name:WERKHOVEN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 89TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1386
Mailing Address - Country:US
Mailing Address - Phone:253-583-1287
Mailing Address - Fax:253-589-4125
Practice Address - Street 1:VA PUGET SOUND HEALTH CARE SYSTEM A 112 VIST
Practice Address - Street 2:9600 VETERANS DRIVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98393-5000
Practice Address - Country:US
Practice Address - Phone:253-583-1287
Practice Address - Fax:253-589-4125
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical