Provider Demographics
NPI:1821149089
Name:DALTON, ANNE GLADYS (MSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:GLADYS
Last Name:DALTON
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 1:618 S PEABODY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6244
Mailing Address - Country:US
Mailing Address - Phone:360-457-1610
Mailing Address - Fax:360-457-8650
Practice Address - Street 1:618 S PEABODY ST
Practice Address - Street 2:SUITE F
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6244
Practice Address - Country:US
Practice Address - Phone:360-457-1610
Practice Address - Fax:360-457-8650
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000057701041C0700X
WALF00001422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist