Provider Demographics
NPI:1174362271
Name:SISOVAN, SUNAREY (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:SUNAREY
Middle Name:
Last Name:SISOVAN
Suffix:
Gender:
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W RIVERSIDE AVE STE 8183
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-765-5351
Practice Address - Street 1:16718 23RD AVENUE CT E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-4549
Practice Address - Country:US
Practice Address - Phone:425-366-7957
Practice Address - Fax:253-765-5351
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC616838651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical