Provider Demographics
NPI:1760101380
Name:KLEIN, ELIZABETH (LSWAIC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 EVANS CT
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8756
Mailing Address - Country:US
Mailing Address - Phone:253-666-9950
Mailing Address - Fax:
Practice Address - Street 1:1226 EVANS CT
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8756
Practice Address - Country:US
Practice Address - Phone:253-666-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASWIA.SC.613529011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical