Provider Demographics
NPI:1558467589
Name:HAROLDSEN, STEPHANIE K (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:K
Last Name:HAROLDSEN
Suffix:
Gender:F
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:PO BOX 1353
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-1353
Mailing Address - Country:US
Mailing Address - Phone:425-577-8183
Mailing Address - Fax:
Practice Address - Street 1:220 S 3RD PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-2405
Practice Address - Country:US
Practice Address - Phone:425-228-0074
Practice Address - Fax:425-226-2531
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000087351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical