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General NPI Number Information
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NPI Number | 1902513369
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Entity Type | Individual
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Provider Name | LEA TATE LSWAIC
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Gender | Female
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Dates
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Enumeration Date | 11/03/2022
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 102 23RD AVE SE UNIT 102
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City | PUYALLUP
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State | WA
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Zip | 98372-4501
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Country | US
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Telephone | 253-987-5561
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Fax |
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Provider Business Mailing Address
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Address Line | 16909 132ND AVE E
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City | PUYALLUP
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State | WA
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Zip | 98374-9570
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Country | US
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Telephone | 864-735-6577
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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 | SC61333093
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License Number State | WA
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