Healthcare Provider Details

I. General information

NPI: 1902754658
Provider Name (Legal Business Name): TESSA CARPENTER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 N SHIRLEY ST STE 100
RUSTON WA
98407-6599
US

IV. Provider business mailing address

5219 N SHIRLEY ST STE 100
RUSTON WA
98407-6599
US

V. Phone/Fax

Practice location:
  • Phone: 253-434-4220
  • Fax: 253-750-7003
Mailing address:
  • Phone: 253-434-4220
  • Fax: 253-750-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61476982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: