Provider Demographics
NPI:1659685675
Name:MACIOSEK, TAMRIA L (LMSW)
Entity Type:Individual
Prefix:
First Name:TAMRIA
Middle Name:L
Last Name:MACIOSEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 N. IRONWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:COEUR D' ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-655-1700
Mailing Address - Fax:
Practice Address - Street 1:4815 N. ASSEMBLY ST.
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6197
Practice Address - Country:US
Practice Address - Phone:208-655-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW289271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical