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General NPI Number Information
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NPI Number | 1376530584
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Entity Type | Individual
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Provider Name | SIMON B. PAQUETTE LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 18608 SE 36TH CIR
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City | VANCOUVER
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State | WA
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Zip | 98683-8244
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Country | US
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Telephone | 360-903-4385
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Fax | 360-449-0009
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Provider Business Mailing Address
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Address Line | 18608 SE 36TH CIR
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City | VANCOUVER
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State | WA
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Zip | 98683-8244
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Country | US
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Telephone | 360-903-4385
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Fax | 360-449-0009
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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 | 2650
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60041917
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License Number State | WA
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