Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LW60312254 | WA |
NPI | 1003334160 |
---|---|
Provider Name | Mrs. Trinese Clark |
First Address | Seattle, WA 98144-4009 |
Second Address | Kent, WA 98032-5749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 08/09/2017 |