Provider Demographics
NPI:1285112763
Name:WALLER, SHERI LYNN (MSW, LCSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:WALLER
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 TERRY AVE
Mailing Address - Street 2:UNIT 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2020
Mailing Address - Country:US
Mailing Address - Phone:208-948-9483
Mailing Address - Fax:
Practice Address - Street 1:535 DOCK ST STE 108
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4629
Practice Address - Country:US
Practice Address - Phone:208-948-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601490851041C0700X
ID378321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical