Provider Demographics
NPI:1629264411
Name:VANDERMAUSE, DENNIS J (LCSW)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:VANDERMAUSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16416 N GREENBLUFF RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-8505
Mailing Address - Country:US
Mailing Address - Phone:509-534-1731
Mailing Address - Fax:509-535-7073
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE 690
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-534-1731
Practice Address - Fax:509-535-7073
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000093721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical