Provider Demographics
NPI:1376608000
Name:NELSON, SHARON J (MA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:J
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:906 W 2ND AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4538
Mailing Address - Country:US
Mailing Address - Phone:509-458-7641
Mailing Address - Fax:509-624-1216
Practice Address - Street 1:906 W 2ND AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4538
Practice Address - Country:US
Practice Address - Phone:509-458-7641
Practice Address - Fax:509-624-1216
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005230101YM0800X
WALF00001657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3258NEOtherREGENCE BLUE SHIELD ID #