Provider Demographics
NPI:1740463850
Name:FABIANSON, INGRID SUSANNE (MSW, MDIV)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:SUSANNE
Last Name:FABIANSON
Suffix:
Gender:F
Credentials:MSW, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 LINDER ST
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-8038
Mailing Address - Country:US
Mailing Address - Phone:369-378-1910
Mailing Address - Fax:
Practice Address - Street 1:505 LINDER ST
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8038
Practice Address - Country:US
Practice Address - Phone:369-378-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000050351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical