Provider Demographics
NPI:1942253190
Name:WEAVER, MARGUERITE NONNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:NONNIE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-3409
Mailing Address - Country:US
Mailing Address - Phone:360-425-1322
Mailing Address - Fax:
Practice Address - Street 1:208 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3409
Practice Address - Country:US
Practice Address - Phone:360-425-1322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000056961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWE3213OtherREGENCE BLUE SHIELD OF WA
WAWE3213OtherREGENCE BLUE SHIELD OF WA
WAAB00179Medicare PIN