Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | WA |
NPI | 1003219817 |
---|---|
Provider Name | Corinne Pang |
First Address | Tacoma, WA 98405-2047 |
Second Address | Tacoma, WA 98405-2047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2014 |
Last Update Date | 07/10/2014 |