Provider Demographics
NPI:1295736643
Name:PAUTZ, PETER DENNIS (LICSW, DCSW, BCD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DENNIS
Last Name:PAUTZ
Suffix:
Gender:M
Credentials:LICSW, DCSW, BCD
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 43
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-0043
Mailing Address - Country:US
Mailing Address - Phone:425-388-0200
Mailing Address - Fax:
Practice Address - Street 1:2230 RUCKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2772
Practice Address - Country:US
Practice Address - Phone:425-388-0200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical