Provider Demographics
NPI:1316106198
Name:TALACKO, TONY (MSW)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:TALACKO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:ANTHONY
Other - Last Name:JUINTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 S HOWARD ST STE 321
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-3816
Mailing Address - Country:US
Mailing Address - Phone:509-838-4128
Mailing Address - Fax:509-838-4816
Practice Address - Street 1:110 W K ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2944
Practice Address - Country:US
Practice Address - Phone:360-426-1696
Practice Address - Fax:360-427-0357
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60150687104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker