Provider Demographics
NPI:1942846548
Name:LYMANGROVER CONNORS, SALLY JANE (LICSW)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JANE
Last Name:LYMANGROVER CONNORS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:JANE
Other - Last Name:LYMANGROVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:413 GUPTIL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1741
Mailing Address - Country:US
Mailing Address - Phone:253-334-7834
Mailing Address - Fax:
Practice Address - Street 1:34617 11TH PL S STE 201
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8706
Practice Address - Country:US
Practice Address - Phone:253-334-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608274841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical