Provider Demographics
NPI:1083206429
Name:NIEMITALO, GRACE (MSW, PCSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:NIEMITALO
Suffix:
Gender:F
Credentials:MSW, PCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S WOLCOTT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2882
Mailing Address - Country:US
Mailing Address - Phone:307-333-5370
Mailing Address - Fax:307-333-5371
Practice Address - Street 1:500 S WOLCOTT ST STE 103
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2882
Practice Address - Country:US
Practice Address - Phone:307-333-5370
Practice Address - Fax:307-333-5371
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-9441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA