Provider Demographics
NPI:1275073447
Name:ALTMAIER, BRIAN G (MSW, LSWAID)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:ALTMAIER
Suffix:
Gender:M
Credentials:MSW, LSWAID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12117 W CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:AIRWAY HEIGHTS
Mailing Address - State:WA
Mailing Address - Zip Code:99001-9431
Mailing Address - Country:US
Mailing Address - Phone:509-904-9482
Mailing Address - Fax:
Practice Address - Street 1:12117 W CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9431
Practice Address - Country:US
Practice Address - Phone:509-904-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC6142901491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical