Healthcare Provider Details

I. General information

NPI: 1447453956
Provider Name (Legal Business Name): NATHIRA JANUSSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE RIES BRIGGANCE

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 09/18/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE 9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

9040 JACKSON AVE 9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax:
Mailing address:
  • Phone: 253-968-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00052137
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61363098
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: