Provider Demographics
NPI:1689278939
Name:EMERSON, MALLORY (CD(PALS), CFSD(BADT))
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:CD(PALS), CFSD(BADT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18201 NE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-8234
Mailing Address - Country:US
Mailing Address - Phone:859-229-9126
Mailing Address - Fax:
Practice Address - Street 1:18201 NE 186TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-8234
Practice Address - Country:US
Practice Address - Phone:859-229-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula