Healthcare Provider Details

I. General information

NPI: 1710310883
Provider Name (Legal Business Name): STELLA ELIZABETH HERBERT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18402-103RD ST. NE
BOTHELL WA
98011
US

IV. Provider business mailing address

PO BOX 14429
MILL CREEK WA
98082-2429
US

V. Phone/Fax

Practice location:
  • Phone: 206-817-8904
  • Fax:
Mailing address:
  • Phone: 206-817-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00008704
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: