Provider Demographics
NPI:1932610235
Name:NAM, MICHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NAM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 E STATE ROUTE 4 UNIT 3
Mailing Address - Street 2:
Mailing Address - City:CATHLAMET
Mailing Address - State:WA
Mailing Address - Zip Code:98612-9562
Mailing Address - Country:US
Mailing Address - Phone:360-910-0683
Mailing Address - Fax:
Practice Address - Street 1:266 E STATE ROUTE 4 UNIT 3
Practice Address - Street 2:
Practice Address - City:CATHLAMET
Practice Address - State:WA
Practice Address - Zip Code:98612-9562
Practice Address - Country:US
Practice Address - Phone:360-910-0683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker