Healthcare Provider Details

I. General information

NPI: 1649464629
Provider Name (Legal Business Name): LINDA SUE CLEMENTS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14016 A ST S
TACOMA WA
98444-4662
US

IV. Provider business mailing address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

V. Phone/Fax

Practice location:
  • Phone: 253-503-3649
  • Fax: 253-000-0000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00058036
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG60146784
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60146784
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60202571
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC60202439
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA60192519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: