Provider Demographics
NPI:1689045320
Name:WASHBURN, BARRY WALLACE
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WALLACE
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BARRY
Other - Middle Name:WALLACE
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2808 1/2 BENCH DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1506
Mailing Address - Country:US
Mailing Address - Phone:360-533-1874
Mailing Address - Fax:
Practice Address - Street 1:224 E WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6513
Practice Address - Country:US
Practice Address - Phone:360-532-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR852104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker