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General NPI Number Information
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NPI Number | 1245665025
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Entity Type | Individual
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Provider Name | DAVID LEE MOEGLEIN MSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 4807 NE 142ND ST
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City | VANCOUVER
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State | WA
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Zip | 98686-2213
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Country | US
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Telephone | 602-888-1562
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Fax | 360-846-2820
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Provider Business Mailing Address
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Address Line | 13023 NE HIGHWAY 99 SUITE 7-287
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City | VANCOUVER
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State | WA
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Zip | 98686-2767
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Country | US
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Telephone | 360-907-2376
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Fax |
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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 | LW 60271873
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License Number State | WA
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