Provider Demographics
NPI:1053937235
Name:CANNON, EMMORIE A
Entity type:Individual
Prefix:
First Name:EMMORIE
Middle Name:A
Last Name:CANNON
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 1:16710 SMOKEY POINT BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8435
Mailing Address - Country:US
Mailing Address - Phone:360-363-4234
Mailing Address - Fax:
Practice Address - Street 1:16710 SMOKEY POINT BLVD STE 402
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8435
Practice Address - Country:US
Practice Address - Phone:360-363-4234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician