Provider Demographics
NPI:1902179583
Name:KINCAID, TERESA JILL
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JILL
Last Name:KINCAID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-5001
Mailing Address - Country:US
Mailing Address - Phone:509-747-8224
Mailing Address - Fax:
Practice Address - Street 1:1402 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-5001
Practice Address - Country:US
Practice Address - Phone:509-747-8224
Practice Address - Fax:509-747-0609
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health