Provider Demographics
NPI:1366682643
Name:EMMERT, JOHN W
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:EMMERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 I ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-2411
Mailing Address - Country:US
Mailing Address - Phone:253-833-7444
Mailing Address - Fax:253-735-4111
Practice Address - Street 1:2704 I ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-2411
Practice Address - Country:US
Practice Address - Phone:253-833-7444
Practice Address - Fax:253-735-4111
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health