Provider Demographics
NPI:1487412789
Name:LAL, SWASTIKA LATASHA (LSWAIC)
Entity type:Individual
Prefix:
First Name:SWASTIKA
Middle Name:LATASHA
Last Name:LAL
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:
Other - Last Name:SHANKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:133 124TH ST SE APT D204
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5787
Mailing Address - Country:US
Mailing Address - Phone:240-466-6413
Mailing Address - Fax:
Practice Address - Street 1:133 124TH ST SE APT D204
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5787
Practice Address - Country:US
Practice Address - Phone:253-315-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC614514081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical