Provider Demographics
NPI:1114797792
Name:STADLER, EMMA CLARISSA
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:CLARISSA
Last Name:STADLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2892 COVENTRY LN SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-0489
Mailing Address - Country:US
Mailing Address - Phone:564-201-8204
Mailing Address - Fax:
Practice Address - Street 1:1217 COOPER POINT RD SW STE 5
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-7206
Practice Address - Country:US
Practice Address - Phone:360-464-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician