Provider Demographics
NPI:1063563856
Name:TUCKER, PATRICIA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 4TH AVE E STE 200
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4280
Mailing Address - Country:US
Mailing Address - Phone:360-570-1161
Mailing Address - Fax:360-786-1089
Practice Address - Street 1:1211 4TH AVE E STE 200
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4280
Practice Address - Country:US
Practice Address - Phone:360-570-1161
Practice Address - Fax:360-786-1089
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000086531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8867702Medicare PIN