Provider Demographics
NPI:1679398770
Name:WILLETT, SELONA (LASW)
Entity type:Individual
Prefix:
First Name:SELONA
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WILLAMETTE DR NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-6266
Mailing Address - Country:US
Mailing Address - Phone:360-493-7469
Mailing Address - Fax:360-216-4426
Practice Address - Street 1:3020 WILLAMETTE DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6266
Practice Address - Country:US
Practice Address - Phone:360-493-7469
Practice Address - Fax:360-216-4426
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603350821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical