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General NPI Number Information
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NPI Number | 1306917059
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Entity Type | Individual
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Provider Name | KELLEY SUE WEST LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20174 FRONT ST FRONT STREET CLINIC
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City | POULSBO
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State | WA
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Zip | 98370
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Country | US
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Telephone | 360-697-1141
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Fax | 360-697-2395
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Provider Business Mailing Address
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Address Line | PO BOX 1611
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City | POULSBO
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State | WA
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Zip | 98370
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Country | US
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Telephone | 360-697-1141
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Fax | 360-697-2395
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LW00006376
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License Number State | WA
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