Provider Demographics
NPI:1598912594
Name:SIROTKIN, LAURIE ANNE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:SIROTKIN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WALW603221001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2040618Medicaid