Provider Demographics
NPI:1376702894
Name:WOLTEMATH, ELLEN (MSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WOLTEMATH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18521 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9798
Mailing Address - Country:US
Mailing Address - Phone:509-230-8706
Mailing Address - Fax:
Practice Address - Street 1:2901 W FORT GEORGE WRIGHT DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5202
Practice Address - Country:US
Practice Address - Phone:509-326-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009344101YM0800X
WALW000086441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health