Provider Demographics
NPI:1124093364
Name:CHASE, CARLA SUE (SOCIAL WORKER)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:SUE
Last Name:CHASE
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40717 5TH AVE. S.
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-0000
Mailing Address - Country:US
Mailing Address - Phone:253-968-4193
Mailing Address - Fax:253-968-4249
Practice Address - Street 1:40717 5TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-0000
Practice Address - Country:US
Practice Address - Phone:253-968-4193
Practice Address - Fax:253-968-4249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000060131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical