Healthcare Provider Details

I. General information

NPI: 1659676898
Provider Name (Legal Business Name): DIANNA MARIE MOLDOVAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5428 W CLEARWATER AVE STE C-110
KENNEWICK WA
99336-1905
US

IV. Provider business mailing address

5428 W CLEARWATER AVE STE C-110
KENNEWICK WA
99336-1905
US

V. Phone/Fax

Practice location:
  • Phone: 509-531-6664
  • Fax:
Mailing address:
  • Phone: 509-531-6664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.60267243
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: