Provider Demographics
NPI:1750386520
Name:LILLY, KAREN LYNN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:LILLY
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 1:251 MCDONALD RD
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-9559
Mailing Address - Country:US
Mailing Address - Phone:360-384-2259
Mailing Address - Fax:
Practice Address - Street 1:251 MCDONALD RD
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-9559
Practice Address - Country:US
Practice Address - Phone:360-384-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000051761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical