Healthcare Provider Details

I. General information

NPI: 1508287525
Provider Name (Legal Business Name): EMILY MANASSERO L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY AGER LM, IBCLC

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S UNION AVE STE B1
TACOMA WA
98405-1907
US

IV. Provider business mailing address

1310 S UNION AVE STE B1
TACOMA WA
98405-1907
US

V. Phone/Fax

Practice location:
  • Phone: 253-780-1700
  • Fax:
Mailing address:
  • Phone: 253-780-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60703963
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: