Provider Demographics
NPI:1437138815
Name:TYSON, CHERYL (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 10TH PL S
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6766
Mailing Address - Country:US
Mailing Address - Phone:425-301-1008
Mailing Address - Fax:
Practice Address - Street 1:22 10TH PL S
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6766
Practice Address - Country:US
Practice Address - Phone:425-301-1008
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000078301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical