MEDICARE: NANCY CLOUD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS16056	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS16056	OTHER	CA	LICENSED CLINICAL SW

General Provider Information

NPI Number	:	1144225004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY CLOUD LCSW

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	BURLEY
State	:	WA
Zip	:	98322-0159
Country	:	US
Telephone Number	:	253-514-3050
Fax Number	:

Provider Business Practice Location Address
First Line	:	15570 DIAZ PL SW
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-6703
Country	:	US
Telephone Number	:	253-514-3005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/06/2012

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