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General NPI Number Information
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NPI Number | 1851346969
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Entity Type | Individual
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Provider Name | DWAYNE ANTONIO ELDER MSW
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Gender | Male
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9040 A REID STREET
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-565-2481
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Fax |
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Provider Business Mailing Address
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Address Line | 4902 76TH AVENUE CT W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-4579
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Country | US
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Telephone |
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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 | 6801074453
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License Number State | MI
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