Basic Information
Provider Information
NPI: 1538191853
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALMEDA
FirstName: SHERRIE
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: KOFFORD
OtherFirstName: SHERRIE
OtherMiddleName: L
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 315 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984054234
CountryCode: US
TelephoneNumber: 2534031126
FaxNumber:  
Practice Location
Address1: 315 MARTIN LUTHER KING JR WAY
Address2:  
City: TACOMA
State: WA
PostalCode: 984054234
CountryCode: US
TelephoneNumber: 2534031126
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 06/12/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XRC00047192WAN Behavioral Health & Social Service ProvidersCounselor 
104100000XLW60186704WAN Behavioral Health & Social Service ProvidersSocial Worker 
1041C0700XLW60186704WAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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