Provider Demographics
NPI:1871676445
Name:RUSTAD, NATASHA ANNE (LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANNE
Last Name:RUSTAD
Suffix:
Gender:F
Credentials:LICSW, LCSW
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 3192
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0366
Mailing Address - Country:US
Mailing Address - Phone:541-708-1979
Mailing Address - Fax:
Practice Address - Street 1:56 N COLLEGE AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:COLLEGE PLACE
Practice Address - State:WA
Practice Address - Zip Code:99324-4069
Practice Address - Country:US
Practice Address - Phone:509-730-9894
Practice Address - Fax:844-512-2575
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL50281041C0700X
WALW 601186021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical