Provider Demographics
NPI:1679808703
Name:ENGLUND, NORMAN PHILIP (MSW)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:PHILIP
Last Name:ENGLUND
Suffix:
Gender:M
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 189
Mailing Address - Street 2:
Mailing Address - City:LA PUSH
Mailing Address - State:WA
Mailing Address - Zip Code:98350-0189
Mailing Address - Country:US
Mailing Address - Phone:360-374-4320
Mailing Address - Fax:360-374-4326
Practice Address - Street 1:560 QUILEUTE HEIGHTS
Practice Address - Street 2:
Practice Address - City:LAPUSH
Practice Address - State:WA
Practice Address - Zip Code:98350
Practice Address - Country:US
Practice Address - Phone:360-374-4320
Practice Address - Fax:360-374-4326
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004403101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7084486Medicaid