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NPI Code Detail

MEDICARE: LYNN HACKSTAFF LICSW

MEDICARE: LYNN HACKSTAFF LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantLCS11925CA
21041C0700XClinical Social WorkerLW60995388WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
160995388OTHERWAINDEPENDENT CLINICAL SOCIAL WORKER LICENSE

General Provider Information

NPI Number : 1033313184
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN HACKSTAFF LICSW
Provider Business Mailing Address
First Line : 1021 SE EVERETT MALL WAY UNIT L
Second Line :
City : EVERETT
State : WA
Zip : 98208-2809
Country : US
Telephone Number : 310-619-5085
Fax Number :
Provider Business Practice Location Address
First Line : 6505 216TH ST SW STE 100
Second Line :
City : MOUNTLAKE TERRACE
State : WA
Zip : 98043-2089
Country : US
Telephone Number : 425-640-7009
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/30/2021

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Directions to “ LYNN HACKSTAFF LICSW” Practice Location

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