Basic Information
| Provider Information | |||||||||
| NPI: | 1750782223 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STURGES | ||||||||
| FirstName: | STACI | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW, LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E 33RD ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986632776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605147489 | ||||||||
| FaxNumber: | 3605147553 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E 33RD ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986632776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605147489 | ||||||||
| FaxNumber: | 3605147553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LW60157818 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | LW60157818 | 01 | WA | SOCIAL WORKER INDEPENDENT CLINICAL LICENSE ISSUED BY WA DOH | OTHER |