Healthcare Provider Details

I. General information

NPI: 1669955589
Provider Name (Legal Business Name): OLIVIA DANIELLE NOELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 100TH ST SE STE B
EVERETT WA
98208-3832
US

IV. Provider business mailing address

2781 S 242ND ST
DES MOINES WA
98198-5166
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-0204
  • Fax:
Mailing address:
  • Phone: 206-212-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC60887366
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: