Provider Demographics
NPI:1497228209
Name:LAURIE A SIROTKIN MSW LICSW PLLC
Entity Type:Organization
Organization Name:LAURIE A SIROTKIN MSW LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICSW
Authorized Official - Phone:888-365-3637
Mailing Address - Street 1:PO BOX 15178
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-3178
Mailing Address - Country:US
Mailing Address - Phone:888-365-3637
Mailing Address - Fax:425-483-1841
Practice Address - Street 1:19101 36TH AVE W STE 208
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5759
Practice Address - Country:US
Practice Address - Phone:888-365-3637
Practice Address - Fax:425-483-1841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040618Medicaid