Provider Demographics
NPI:1699484568
Name:NEITZEL, VIOLET EMILIANNE (LSWAIC)
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:EMILIANNE
Last Name:NEITZEL
Suffix:
Gender:F
Credentials:LSWAIC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:NEITZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:167 11TH AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5490
Mailing Address - Country:US
Mailing Address - Phone:317-361-6455
Mailing Address - Fax:
Practice Address - Street 1:1600 S LANE ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2810
Practice Address - Country:US
Practice Address - Phone:206-682-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC613271211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC61327121OtherWASHINGTON STATE DEPT OF HEALTH