Provider Demographics
NPI:1235479833
Name:BUCKLES, ALICE YVETTE (LICSW)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:YVETTE
Last Name:BUCKLES
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 1:16540 N MORTON DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-7532
Mailing Address - Country:US
Mailing Address - Phone:509-263-3717
Mailing Address - Fax:509-535-4069
Practice Address - Street 1:16540 N MORTON DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-7532
Practice Address - Country:US
Practice Address - Phone:509-263-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603158011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical