Provider Demographics
NPI:1508821042
Name:ENDYKE, PETER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ENDYKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 N DIVISION ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6545
Mailing Address - Country:US
Mailing Address - Phone:509-464-0300
Mailing Address - Fax:509-468-2479
Practice Address - Street 1:7307 N DIVISION ST
Practice Address - Street 2:SUITE 311
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6545
Practice Address - Country:US
Practice Address - Phone:509-464-0300
Practice Address - Fax:509-468-2479
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858026Medicare ID - Type Unspecified