Provider Demographics
NPI:1740418276
Name:FENDER, DOUGLAS R (MSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:FENDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-4412
Mailing Address - Country:US
Mailing Address - Phone:509-462-2500
Mailing Address - Fax:509-462-2503
Practice Address - Street 1:705 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-4412
Practice Address - Country:US
Practice Address - Phone:509-462-2500
Practice Address - Fax:509-462-2503
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28638104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker