Healthcare Provider Details

I. General information

NPI: 1659019735
Provider Name (Legal Business Name): IRIS GUZMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRIS COVARRUBIAS

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 183RD STREET CT E
PUYALLUP WA
98375-6312
US

IV. Provider business mailing address

9702 183RD STREET CT E
PUYALLUP WA
98375-6312
US

V. Phone/Fax

Practice location:
  • Phone: 253-881-9854
  • Fax:
Mailing address:
  • Phone: 253-881-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: