Provider Demographics
NPI:1063004323
Name:SHIELDS, EMILY CAROLINE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAROLINE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:PINNACLE
Mailing Address - State:NC
Mailing Address - Zip Code:27043-9106
Mailing Address - Country:US
Mailing Address - Phone:509-637-3568
Mailing Address - Fax:
Practice Address - Street 1:19204 NORTH CREEK PARKWAY
Practice Address - Street 2:BUILDING #2, SUITE 110
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:818-241-6853
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician