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General NPI Number Information
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NPI Number | 1356474936
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Entity Type | Individual
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Provider Name | MICHAEL KEVIN STRUB LSW
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 802 39TH AVE SW
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City | PUYALLUP
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State | WA
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Zip | 98373-5915
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Country | US
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Telephone | 253-841-9720
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Fax | 253-770-9568
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Provider Business Mailing Address
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Address Line | 2109 MCELROY PL
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City | PUYALLUP
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State | WA
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Zip | 98371-5004
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Country | US
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Telephone | 253-841-9720
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Fax | 253-770-9568
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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 | LW00004263
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License Number State | WA
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