Provider Demographics
NPI:1477977288
Name:GULICK, DIANNA
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:GULICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 E SPRINGFIELD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2913
Mailing Address - Country:US
Mailing Address - Phone:509-242-7211
Mailing Address - Fax:
Practice Address - Street 1:1817 E SPRINGFIELD AVE STE E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2913
Practice Address - Country:US
Practice Address - Phone:509-242-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60550063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health