Provider Demographics
NPI:1649517350
Name:GUERTIN, KARIN (MSW)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:MSW
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 369
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648
Mailing Address - Country:US
Mailing Address - Phone:509-427-3850
Mailing Address - Fax:509-427-0188
Practice Address - Street 1:710 SW ROCK CREEK DR.
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98348-4418
Practice Address - Country:US
Practice Address - Phone:509-427-3850
Practice Address - Fax:509-427-0188
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC605042961041S0200X
OR8020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant