Active NPI
Lynn Hackstaff, LICSW
- Clinical Social Worker
- Mountlake Terrace, WA
National Provider Identifier
1033313184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW60995388
- Practice address
- 6505 216TH St SW Ste 100
Mountlake Terrace, WA 98043-2089 - Phone
- (425) 640-7009
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | LCS11925 | CA | |
| Clinical Social Worker | 1041C0700X | LW60995388 | WA | Primary |
Addresses
Primary practice location
6505 216TH St SW Ste 100
Mountlake Terrace, WA 98043-2089
Mailing address
1021 SE Everett Mall Way Unit L
Everett, WA 98208-2809
Phone (310) 619-5085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60995388 | Other | WA | INDEPENDENT CLINICAL SOCIAL WORKER LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW60995388 | WA | MD | Clinical Social Worker |
| LCS11925 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627603200000",
"number": "1033313184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1021 SE EVERETT MALL WAY UNIT L",
"city": "EVERETT",
"state": "WA",
"postal_code": "982082809",
"telephone_number": "310-619-5085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6505 216TH ST SW STE 100",
"city": "MOUNTLAKE TERRACE",
"state": "WA",
"postal_code": "980432089",
"telephone_number": "425-640-7009"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKSTAFF",
"first_name": "LYNN",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2021-07-30",
"certification_date": "2021-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "LCS11925",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW60995388",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDEPENDENT CLINICAL SOCIAL WORKER LICENSE",
"identifier": "60995388",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountlake Terrace, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.