Provider Demographics
NPI:1114659307
Name:MOWRER, EMILY KATHRYN
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:MOWRER
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 1:4050 W LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5938
Mailing Address - Country:US
Mailing Address - Phone:425-922-6056
Mailing Address - Fax:
Practice Address - Street 1:5031 UNIVERSITY WAY NE UNIT 105
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4341
Practice Address - Country:US
Practice Address - Phone:206-427-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61241743106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician