Provider Demographics
NPI:1619226339
Name:VITMAN, SPOMENKA (MA)
Entity Type:Individual
Prefix:
First Name:SPOMENKA
Middle Name:
Last Name:VITMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 NE 79TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4466
Mailing Address - Country:US
Mailing Address - Phone:425-681-5330
Mailing Address - Fax:
Practice Address - Street 1:16710 NE 79TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4466
Practice Address - Country:US
Practice Address - Phone:425-681-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60558559101YM0800X
WAMC60405600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health