Provider Demographics
NPI:1700563509
Name:CHANTEL, CHRISTY LYNN (LISW)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:CHANTEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LYNN
Other - Last Name:WIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13451 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1454
Mailing Address - Country:US
Mailing Address - Phone:425-562-1337
Mailing Address - Fax:425-562-1331
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1337
Practice Address - Fax:425-562-1331
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614189931041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker