Provider Demographics
NPI:1508332909
Name:LONGHOFER, KIM ANNE (BSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANNE
Last Name:LONGHOFER
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ANNE
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:312 W 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2506
Mailing Address - Country:US
Mailing Address - Phone:509-477-4383
Mailing Address - Fax:509-477-3615
Practice Address - Street 1:312 W 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2506
Practice Address - Country:US
Practice Address - Phone:509-477-4383
Practice Address - Fax:509-477-3615
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60154893Medicaid