Active NPI
Sally Dullum, LICSW
- Clinical Social Worker
- Tacoma, WA
National Provider Identifier
1720594823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LW60070761
- Practice address
- 1919 N Pearl St Ste C3
Tacoma, WA 98406-2490 - Phone
- (253) 752-1860
- NPI assigned
- Dec 27, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LW60070761 | WA | Primary |
Addresses
Primary practice location
1919 N Pearl St Ste C3
Tacoma, WA 98406-2490
Mailing address
1919 N Pearl St Ste C3
Tacoma, WA 98406-2490
Phone (253) 752-1860
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LW60070761 | WA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514332800000",
"number": "1720594823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1919 N PEARL ST STE C3",
"city": "TACOMA",
"state": "WA",
"postal_code": "984062490",
"telephone_number": "253-752-1860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1919 N PEARL ST STE C3",
"city": "TACOMA",
"state": "WA",
"postal_code": "984062490",
"telephone_number": "253-752-1860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DULLUM",
"first_name": "SALLY",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-27",
"last_updated": "2017-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WA",
"license": "LW60070761",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.