Provider Demographics
NPI:1437208881
Name:SMITH, COLEEN E (LAC)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 E BROADWAY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6132
Mailing Address - Country:US
Mailing Address - Phone:509-928-2777
Mailing Address - Fax:509-928-2778
Practice Address - Street 1:12211 E BROADWAY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6132
Practice Address - Country:US
Practice Address - Phone:509-928-2777
Practice Address - Fax:509-928-2778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist