Provider Demographics
NPI:1710760673
Name:DAVIS, BERNEDETTE (MSW, LSWAIC)
Entity Type:Individual
Prefix:
First Name:BERNEDETTE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4153
Mailing Address - Country:US
Mailing Address - Phone:509-547-2204
Mailing Address - Fax:
Practice Address - Street 1:715 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4153
Practice Address - Country:US
Practice Address - Phone:509-547-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61420967104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker