Provider Demographics
NPI:1255456521
Name:DUNLOP, MYRNA LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:LYNN
Last Name:DUNLOP
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 1:1715 114TH AVE SE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6945
Mailing Address - Country:US
Mailing Address - Phone:425-451-2116
Mailing Address - Fax:
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 204
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:425-451-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000045891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB38106Medicare ID - Type Unspecified