=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407224330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMA NIERMAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2015
-----------------------------------------------------
Last Update Date | 09/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 S 2ND ST SUITE 2
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-203-7223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 S 2ND ST SUITE 2
-----------------------------------------------------
City | RENTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98057-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-203-7201
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | EMMA NIERMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-681-2459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW60539423
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------