Provider Demographics
NPI:1255982682
Name:MICHAELIS, MARYANN H (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:H
Last Name:MICHAELIS
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 LETHBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7810
Mailing Address - Country:US
Mailing Address - Phone:509-416-0224
Mailing Address - Fax:
Practice Address - Street 1:925 STEVENS DR STE 3A
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3523
Practice Address - Country:US
Practice Address - Phone:509-416-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60962751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker