Provider Demographics
NPI:1144719782
Name:CAMPBELL, CANDY ANN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CANDY
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-716-5796
Mailing Address - Fax:
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0003
Practice Address - Country:US
Practice Address - Phone:253-583-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL76541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical