Provider Demographics
NPI:1427220425
Name:LACELLE, MARILYN ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:ANN
Last Name:LACELLE
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 1:2190 NW COYOTE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5604
Mailing Address - Country:US
Mailing Address - Phone:425-392-8973
Mailing Address - Fax:
Practice Address - Street 1:2190 NW COYOTE CREEK LN
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5604
Practice Address - Country:US
Practice Address - Phone:425-392-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006687104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00006687OtherLICENSED SOCIAL WORKER