Healthcare Provider Details

I. General information

NPI: 1144071036
Provider Name (Legal Business Name): ALYSSA CAMPBELL LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 168TH ST NE STE A207
ARLINGTON WA
98223-8464
US

IV. Provider business mailing address

3710 168TH ST NE STE A207
ARLINGTON WA
98223-8464
US

V. Phone/Fax

Practice location:
  • Phone: 360-218-4645
  • Fax: 360-218-4645
Mailing address:
  • Phone: 360-218-4645
  • Fax: 360-218-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61535655
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: