Provider Demographics
NPI:1437877677
Name:MIKNIS, EMILY NICOLE (LSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:MIKNIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 PINE RUN RD
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-8307
Mailing Address - Country:US
Mailing Address - Phone:814-771-6775
Mailing Address - Fax:
Practice Address - Street 1:1127 PINE RUN RD
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-8307
Practice Address - Country:US
Practice Address - Phone:814-771-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker