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General NPI Number Information
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NPI Number | 1023370681
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Entity Type | Individual
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Provider Name | DIANA LYNN CANFIELD MSW
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 11117 NE 189TH ST SUITE 205
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City | BATTLE GROUND
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State | WA
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Zip | 98604-6244
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Country | US
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Telephone | 360-356-5361
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Fax | 360-666-7098
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Provider Business Mailing Address
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Address Line | 11117 NE 189TH ST SUITE 205
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City | BATTLE GROUND
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State | WA
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Zip | 98604-6244
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Country | US
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Telephone | 360-356-5361
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Fax | 360-666-7098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SC60164205
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License Number State | WA
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