Provider Demographics
NPI:1417572009
Name:OSTERMICK-DURKEE, MEGAN (LICSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:OSTERMICK-DURKEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-0502
Mailing Address - Country:US
Mailing Address - Phone:360-559-1530
Mailing Address - Fax:
Practice Address - Street 1:6442 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9698
Practice Address - Country:US
Practice Address - Phone:360-559-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WALW61511415104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical