Provider Demographics
NPI:1457482440
Name:RAY-ANNIS, INEZ KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:KATHLEEN
Last Name:RAY-ANNIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHIE
Other - Middle Name:
Other - Last Name:RAY-ANNIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:4205 NE 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7074
Mailing Address - Country:US
Mailing Address - Phone:360-690-6550
Mailing Address - Fax:360-253-6424
Practice Address - Street 1:8000 NE PARKWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6737
Practice Address - Country:US
Practice Address - Phone:360-690-6550
Practice Address - Fax:360-253-6424
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WALW 000096981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW 00009698OtherLICENSED CLINICAL SOCIAL WORKER (LICSW)
WARC00048802OtherREGISTER COUNSELOR