Healthcare Provider Details

I. General information

NPI: 1982901930
Provider Name (Legal Business Name): KAREN DIANE BRUNSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2011
Last Update Date: 02/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CENTRALIA COLLEGE BLVD
CENTRALIA WA
98531-4007
US

IV. Provider business mailing address

2628 ISLAND DR NW
OLYMPIA WA
98502-9710
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-5460
  • Fax:
Mailing address:
  • Phone: 360-280-3393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00006338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: