Provider Demographics
NPI:1437677242
Name:SOTO, KRISSY SUE (LICSW)
Entity type:Individual
Prefix:
First Name:KRISSY
Middle Name:SUE
Last Name:SOTO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 COPPERLEAF ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-5013
Mailing Address - Country:US
Mailing Address - Phone:509-827-0283
Mailing Address - Fax:
Practice Address - Street 1:825 JADWIN AVE STE 250
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3589
Practice Address - Country:US
Practice Address - Phone:509-525-5200
Practice Address - Fax:509-946-0827
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW61521119104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker