Provider Demographics
NPI:1629889704
Name:CANNADY, NIX (LSWAIC)
Entity type:Individual
Prefix:
First Name:NIX
Middle Name:
Last Name:CANNADY
Suffix:
Gender:X
Credentials:LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 W RAILROAD AVE # 216
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-3522
Mailing Address - Country:US
Mailing Address - Phone:360-450-4405
Mailing Address - Fax:
Practice Address - Street 1:625 W RAILROAD AVE # 216
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3522
Practice Address - Country:US
Practice Address - Phone:360-450-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC616452211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical