Provider Demographics
NPI:1790328409
Name:VAN SKIKE, SUSAN E (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:VAN SKIKE
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 1:38503 NW GOOSE HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674
Mailing Address - Country:US
Mailing Address - Phone:360-798-3257
Mailing Address - Fax:
Practice Address - Street 1:38503 NW GOOSE HILL AVENUE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674
Practice Address - Country:US
Practice Address - Phone:360-798-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical