Healthcare Provider Details

I. General information

NPI: 1366042616
Provider Name (Legal Business Name): LIA ROSE TAMMINEN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 150TH AVE SE
BELLEVUE WA
98006-1668
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 425-460-7114
  • Fax: 425-460-7115
Mailing address:
  • Phone: 253-681-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61459532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: