Provider Demographics
NPI:1629654918
Name:SWARTZENDRUBER, ALICIA DE LA ROSA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:DE LA ROSA
Last Name:SWARTZENDRUBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9512 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-6120
Mailing Address - Country:US
Mailing Address - Phone:805-259-6864
Mailing Address - Fax:
Practice Address - Street 1:9512 NW 29TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-6120
Practice Address - Country:US
Practice Address - Phone:805-259-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW611082241041C0700X
CALCSW971041041C0700X
UT11976608-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical