Provider Demographics
NPI:1326585043
Name:NIMIETZ, LINN
Entity Type:Individual
Prefix:
First Name:LINN
Middle Name:
Last Name:NIMIETZ
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 1:8541 CIRCLE R COURSE LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-5903
Mailing Address - Country:US
Mailing Address - Phone:760-522-6379
Mailing Address - Fax:
Practice Address - Street 1:861 HUCKLEBERRY LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-7908
Practice Address - Country:US
Practice Address - Phone:619-458-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6266851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical