1740802925 NPI number — EMILY EAST CRAM MSW, LICSW

Table of content: EMILY EAST CRAM MSW, LICSW (NPI 1740802925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740802925 NPI number — EMILY EAST CRAM MSW, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAM
Provider First Name:
EMILY
Provider Middle Name:
EAST
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOUTSENBERGER
Provider Other First Name:
EMILY
Provider Other Middle Name:
NICOL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740802925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5621
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-358-2238
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-358-2238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: LW61042147 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2172346 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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