Provider Demographics
NPI:1609256445
Name:GIBB, SAMANTHA (MSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GIBB
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 TROSPER RD SW APT G104
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-8127
Mailing Address - Country:US
Mailing Address - Phone:801-502-8237
Mailing Address - Fax:
Practice Address - Street 1:1906 TROSPER RD SW APT G104
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-8127
Practice Address - Country:US
Practice Address - Phone:801-502-8237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT9857245-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program