Provider Demographics
NPI:1639277031
Name:PARDUE, CHERIE V (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CHERIE
Middle Name:V
Last Name:PARDUE
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 1:285 N. 2ND ST.
Mailing Address - Street 2:P.O. BOX 1475
Mailing Address - City:KALAMA
Mailing Address - State:WA
Mailing Address - Zip Code:98625
Mailing Address - Country:US
Mailing Address - Phone:360-673-2053
Mailing Address - Fax:
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:VETERANS ADMINISTRATION (V3-MHC)
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-696-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000072781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical