Provider Demographics
NPI:1659456424
Name:LEE, ELVIE ANN (MSW)
Entity Type:Individual
Prefix:
First Name:ELVIE
Middle Name:ANN
Last Name:LEE
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 1:1761A NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3042
Mailing Address - Country:US
Mailing Address - Phone:206-381-1331
Mailing Address - Fax:425-312-1683
Practice Address - Street 1:2326 RUCKER AVE STE 103
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2723
Practice Address - Country:US
Practice Address - Phone:206-381-1331
Practice Address - Fax:425-312-1638
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000042051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6719LEOtherREGENCE RIDER NUMBER
WA195859OtherVALUE OPTIONS
WA6719LEOtherREGENCE RIDER NUMBER