Provider Demographics
NPI:1528037496
Name:DUSTIN, JUDITH ROSE (LICSW)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ROSE
Last Name:DUSTIN
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 1:917 PACIFIC AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4446
Mailing Address - Country:US
Mailing Address - Phone:253-572-6861
Mailing Address - Fax:253-572-3400
Practice Address - Street 1:917 PACIFIC AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4446
Practice Address - Country:US
Practice Address - Phone:253-572-6861
Practice Address - Fax:253-572-3400
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALICSW 000065651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical