Provider Demographics
NPI:1346600160
Name:SKOK, SANDRA LU
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LU
Last Name:SKOK
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 1:514 S RAY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-5160
Mailing Address - Country:US
Mailing Address - Phone:509-216-8890
Mailing Address - Fax:
Practice Address - Street 1:960 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2241
Practice Address - Country:US
Practice Address - Phone:509-444-7033
Practice Address - Fax:509-444-7038
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007339251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health