Provider Demographics
NPI:1033227129
Name:THIEL, DIANE LINDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LINDA
Last Name:THIEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236
Mailing Address - Country:US
Mailing Address - Phone:808-385-2712
Mailing Address - Fax:
Practice Address - Street 1:2930 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3832
Practice Address - Country:US
Practice Address - Phone:425-261-1776
Practice Address - Fax:425-261-1855
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000095361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILSW228OtherLICENSE IN SOCIAL WORK
WARC00055130OtherREGISTERED COUNSELOR
WAG8881453Medicare PIN
WAG8881454Medicare PIN