Provider Demographics
NPI:1538920582
Name:PICO, EMILY (ICP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PICO
Suffix:
Gender:F
Credentials:ICP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2506
Mailing Address - Country:US
Mailing Address - Phone:253-302-4639
Mailing Address - Fax:
Practice Address - Street 1:3121 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2506
Practice Address - Country:US
Practice Address - Phone:253-302-4639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty