Provider Demographics
NPI:1578015145
Name:DENISON, EDIN (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:EDIN
Middle Name:
Last Name:DENISON
Suffix:
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W BOONE AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2353
Mailing Address - Country:US
Mailing Address - Phone:360-564-0903
Mailing Address - Fax:
Practice Address - Street 1:316 W BOONE AVE STE 850
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2353
Practice Address - Country:US
Practice Address - Phone:360-564-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW614465131041C0700X, 104100000X, 1041C0700X
WASC612791271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2224675Medicaid