MEDICARE: STEFANIE NIESZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW61114191	WA

General Provider Information

NPI Number	:	1023491552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFANIE NIESZ

Provider Business Mailing Address
First Line	:	2815 EASTLAKE AVE E STE 220
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3086
Country	:	US
Telephone Number	:	509-969-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 EASTLAKE AVE E STE 220
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-3086
Country	:	US
Telephone Number	:	509-969-1403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	09/24/2024

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