Provider Demographics
NPI:1437169240
Name:QUACKENBUSH, ROBERT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:QUACKENBUSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W 7TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W 7TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2843
Practice Address - Country:US
Practice Address - Phone:509-220-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist