Provider Demographics
NPI:1053508515
Name:STUCKART, ANN M (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:STUCKART
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S MAPLE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3445
Mailing Address - Country:US
Mailing Address - Phone:509-418-5541
Mailing Address - Fax:509-418-5542
Practice Address - Street 1:628 S MAPLE ST STE 103
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3445
Practice Address - Country:US
Practice Address - Phone:509-418-5541
Practice Address - Fax:509-418-5542
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000095941041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1053508515OtherNPI