Provider Demographics
NPI:1336573112
Name:NIEMITALO, NOAMIE J (BSW, CSW, MS)
Entity Type:Individual
Prefix:
First Name:NOAMIE
Middle Name:J
Last Name:NIEMITALO
Suffix:
Gender:F
Credentials:BSW, CSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PAR DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-7623
Mailing Address - Country:US
Mailing Address - Phone:307-660-1702
Mailing Address - Fax:
Practice Address - Street 1:625 PAR DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-7623
Practice Address - Country:US
Practice Address - Phone:307-686-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
WYCSW-2201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical