Healthcare Provider Details

I. General information

NPI: 1609731264
Provider Name (Legal Business Name): NICOLE ELAINE BOYETT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26812 118TH AVE E
GRAHAM WA
98338-9220
US

IV. Provider business mailing address

180 6TH ST BOX 302
MORTON WA
98356-9800
US

V. Phone/Fax

Practice location:
  • Phone: 253-320-9591
  • Fax:
Mailing address:
  • Phone: 713-423-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWAA.SA.70032893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: