Provider Demographics
NPI:1700905395
Name:LUSKY, JOANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:LUSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:JOANN
Other - Middle Name:LUSKY
Other - Last Name:KASINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:13215 SE MILL PLAIN BLVD
Mailing Address - Street 2:SUITE C8
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6991
Mailing Address - Country:US
Mailing Address - Phone:360-735-1114
Mailing Address - Fax:360-735-0090
Practice Address - Street 1:2502 SE 134TH CT
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-6693
Practice Address - Country:US
Practice Address - Phone:360-735-1114
Practice Address - Fax:360-735-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10841041C0700X
WA12611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical