=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578537239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDRA JEAN DOYLE MSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MADIGAN ARMY MEDICAL CENTER
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-4159
-----------------------------------------------------
Fax | 253-968-2984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10519 NEWMAN AVE SW
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-4186
-----------------------------------------------------
Fax | 253-968-2984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LW00005518
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------