Provider Demographics
NPI:1912012162
Name:ALLEN, ELIZABETH RUTH (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RUTH
Last Name:ALLEN
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 1:1501 1/2 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3309
Mailing Address - Country:US
Mailing Address - Phone:253-222-6103
Mailing Address - Fax:253-403-3555
Practice Address - Street 1:720 6TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4658
Practice Address - Country:US
Practice Address - Phone:253-222-6103
Practice Address - Fax:253-403-3555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical