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General NPI Number Information
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NPI Number | 1558417790
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Entity Type | Individual
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Provider Name | JACQUELINE SHEA VANCE LCSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/27/2007
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 25227 161ST PL SE
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City | COVINGTON
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State | WA
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Zip | 98042-4127
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Country | US
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Telephone | 253-409-8803
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7131
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City | COVINGTON
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State | WA
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Zip | 98042-0041
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Country | US
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Telephone | 253-409-8803
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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 | LCS#20378
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License Number State | CA
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