Provider Demographics
NPI:1598787632
Name:REMY, LADONNA D (LCSW)
Entity Type:Individual
Prefix:
First Name:LADONNA
Middle Name:D
Last Name:REMY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23403 E MISSION AVE STE 220F
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5112
Mailing Address - Country:US
Mailing Address - Phone:509-475-1315
Mailing Address - Fax:
Practice Address - Street 1:23403 E MISSION AVE STE 220F
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5112
Practice Address - Country:US
Practice Address - Phone:509-475-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000070731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858355Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER