Provider Demographics
NPI:1518717727
Name:RODRIGUEZ, LISSA (LAICSW)
Entity Type:Individual
Prefix:MISS
First Name:LISSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LAICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 FOREST AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-2722
Mailing Address - Country:US
Mailing Address - Phone:206-661-8582
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:530-426-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC611695401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical