Provider Demographics
NPI:1770174146
Name:NOLL, ELIZABETH MARIE (SC 60925842)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:NOLL
Suffix:
Gender:F
Credentials:SC 60925842
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 LAKEWOOD DR W APT 6
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3406
Mailing Address - Country:US
Mailing Address - Phone:253-314-9252
Mailing Address - Fax:
Practice Address - Street 1:5900 100TH ST SW STE 17B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2749
Practice Address - Country:US
Practice Address - Phone:253-625-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60925842104100000X
WA60925842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty