Provider Demographics
NPI:1215067418
Name:MORELAND, SUSAN IRENE (MSW,LICSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:IRENE
Last Name:MORELAND
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:MS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:MORELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW LICSW
Mailing Address - Street 1:620 KIRKLAND WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6021
Mailing Address - Country:US
Mailing Address - Phone:425-820-7100
Mailing Address - Fax:844-750-6896
Practice Address - Street 1:620 KIRKLAND WAY STE 104
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6021
Practice Address - Country:US
Practice Address - Phone:425-820-7100
Practice Address - Fax:844-750-6896
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASW000053411041C0700X
WALW000053411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical