Provider Demographics
NPI:1053398305
Name:BADER, TERRY LYNN (MSW LSCW BCD)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:LYNN
Last Name:BADER
Suffix:
Gender:F
Credentials:MSW LSCW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N TACOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3016
Mailing Address - Country:US
Mailing Address - Phone:253-272-2046
Mailing Address - Fax:253-272-2046
Practice Address - Street 1:2205 N TACOMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3016
Practice Address - Country:US
Practice Address - Phone:253-272-2046
Practice Address - Fax:253-272-2046
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LW00004212 WA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB14949Medicare ID - Type Unspecified