Provider Demographics
NPI:1245665025
Name:MOEGLEIN, DAVID LEE (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:MOEGLEIN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13023 NE HIGHWAY 99
Mailing Address - Street 2:SUITE 7-287
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-2767
Mailing Address - Country:US
Mailing Address - Phone:360-907-2376
Mailing Address - Fax:
Practice Address - Street 1:4807 NE 142ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2213
Practice Address - Country:US
Practice Address - Phone:602-888-1562
Practice Address - Fax:360-846-2820
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 602718731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical