Provider Demographics
NPI:1265901706
Name:WALD, SAZI LANE (LSWAIC)
Entity type:Individual
Prefix:
First Name:SAZI
Middle Name:LANE
Last Name:WALD
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LANE
Other - Last Name:WALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 OLYMPIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4033
Mailing Address - Country:US
Mailing Address - Phone:360-207-4467
Mailing Address - Fax:
Practice Address - Street 1:1005 OLYMPIA AVE NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4033
Practice Address - Country:US
Practice Address - Phone:360-207-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X
WASC61038225104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker