Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LW 00009158 | WA |
NPI | 1003052044 |
---|---|
Provider Name | Ms. Larissa D Peay |
First Address | Issaquah, WA 98027-2941 |
Second Address | Issaquah, WA 98027-2941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2008 |
Last Update Date | 13/11/2019 |