Healthcare Provider Details

I. General information

NPI: 1801090741
Provider Name (Legal Business Name): LINDSEY VAAGEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E YAKIMA AVE STE 380
YAKIMA WA
98901-5410
US

IV. Provider business mailing address

402 E YAKIMA AVE STE 380
YAKIMA WA
98901-5410
US

V. Phone/Fax

Practice location:
  • Phone: 509-969-9010
  • Fax: 509-457-2756
Mailing address:
  • Phone: 509-969-9010
  • Fax: 509-457-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60169252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: