Provider Demographics
NPI:1548639867
Name:NIERMAN, EMMA DIANE (LICSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DIANE
Last Name:NIERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 22ND AVE S
Mailing Address - Street 2:21
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2213
Mailing Address - Country:US
Mailing Address - Phone:425-681-2459
Mailing Address - Fax:
Practice Address - Street 1:209 22ND AVE S
Practice Address - Street 2:21
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2213
Practice Address - Country:US
Practice Address - Phone:425-681-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605394231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical