Provider Demographics
NPI:1073851382
Name:RIDGWAY & FORSYTH PSYCHOLOGY, P.S.
Entity Type:Organization
Organization Name:RIDGWAY & FORSYTH PSYCHOLOGY, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-353-9885
Mailing Address - Street 1:628 S MAPLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3445
Mailing Address - Country:US
Mailing Address - Phone:509-353-9885
Mailing Address - Fax:509-353-9886
Practice Address - Street 1:628 S MAPLE ST
Practice Address - Street 2:STE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3445
Practice Address - Country:US
Practice Address - Phone:509-353-9885
Practice Address - Fax:509-353-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2480103TC0700X
WAPY1912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8919067OtherMEDICARE PTAN
WAG8918942OtherMEDICARE PTAN