Provider Demographics
NPI:1184807356
Name:STEVENS, SUE MARY (MSW)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:MARY
Last Name:STEVENS
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:PO BOX 65401
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-1401
Mailing Address - Country:US
Mailing Address - Phone:253-318-4110
Mailing Address - Fax:253-572-8046
Practice Address - Street 1:6314 19TH ST WEST
Practice Address - Street 2:7
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6223
Practice Address - Country:US
Practice Address - Phone:253-318-4110
Practice Address - Fax:253-572-8046
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical