Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Amber Fawn Gentrysouthard, MSW, LICSW

Individual provider Clinical Social Worker · NPI 1902079924

Amber Fawn Gentrysouthard, MSW, LICSW is a Clinical Social Worker in Puyallup, Washington. Qualified in 2005, 21 years ago. Practices with Multicare Health System, a 2,302-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
21
Licensed in
WA
In the registry since
2008
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

325 E Pioneer
Puyallup, WA 98372-3265
Phone: (253) 445-8120
Fax: (253) 697-3730
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LW 60072190 (WA)

Record details

NPI number1902079924
Entity typeIndividual (Type 1)
GenderFemale
Credentials MSW , LICSW
Sole proprietorNo
NPI enumeratedApril 10, 2008
Last updated in NPPESApril 26, 2012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Multicare Health System — 2302 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Puyallup