Healthcare Provider Details

I. General information

NPI: 1851803290
Provider Name (Legal Business Name): NICOLE ANGELICA GRIMALDO LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 213TH AVENUE CT E
LAKE TAPPS WA
98391-6134
US

IV. Provider business mailing address

6226 213TH AVENUE CT E
LAKE TAPPS WA
98391-6134
US

V. Phone/Fax

Practice location:
  • Phone: 206-814-1919
  • Fax:
Mailing address:
  • Phone: 206-814-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: