Provider Demographics
NPI:1093427288
Name:NORIEGA CORNEJO, EDITH ISBEL
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:ISBEL
Last Name:NORIEGA CORNEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:ISBEL
Other - Last Name:NORIEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 MOHAR RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9638
Mailing Address - Country:US
Mailing Address - Phone:509-643-9810
Mailing Address - Fax:
Practice Address - Street 1:1000 WALLACE WAY
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-8805
Practice Address - Country:US
Practice Address - Phone:509-882-8918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor