Provider Demographics
NPI:1497377238
Name:FERGUSON, PATRICIA JANELLE (LICSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANELLE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 W JAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6771
Mailing Address - Country:US
Mailing Address - Phone:509-998-3844
Mailing Address - Fax:509-381-3538
Practice Address - Street 1:421 W RIVERSIDE AVE STE 340
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5092
Practice Address - Country:US
Practice Address - Phone:509-998-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW604982851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical