Provider Demographics
NPI:1407419575
Name:SIVANISH, DUANE (CDP)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:SIVANISH
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2010
Mailing Address - Country:US
Mailing Address - Phone:509-324-1477
Mailing Address - Fax:509-327-0163
Practice Address - Street 1:5600 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0220
Practice Address - Country:US
Practice Address - Phone:509-533-6910
Practice Address - Fax:509-535-2863
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60670638101YA0400X
WACP61128453101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60670638OtherSTATE