Provider Demographics
NPI:1518076504
Name:GROTSKY, LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GROTSKY
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 1:2419 CARPENTER RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3429
Mailing Address - Country:US
Mailing Address - Phone:360-923-2080
Mailing Address - Fax:360-412-1319
Practice Address - Street 1:3627 ENSIGN RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98506-5024
Practice Address - Country:US
Practice Address - Phone:360-923-2080
Practice Address - Fax:360-412-1319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical