Provider Demographics
NPI:1841599909
Name:BEAM-BRUCE, STACIE MICHELLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:MICHELLE
Last Name:BEAM-BRUCE
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 1:14624 448TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-9768
Mailing Address - Country:US
Mailing Address - Phone:425-202-5653
Mailing Address - Fax:
Practice Address - Street 1:401 BALLARAT AVE N
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8191
Practice Address - Country:US
Practice Address - Phone:425-202-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601721121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical