Provider Demographics
NPI:1902373228
Name:WACHTEL, SHANAY ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:SHANAY
Middle Name:ELIZABETH
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHANAY
Other - Middle Name:ELIZABETH
Other - Last Name:TETHEROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:511 N ARGONNE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2878
Mailing Address - Country:US
Mailing Address - Phone:208-446-6578
Mailing Address - Fax:
Practice Address - Street 1:317 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5120
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:509-363-2762
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC60986047104100000X
WACG60970645390200000X
WALW613412901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW61341290OtherWASHINGTON DEPARTMENT OF HEALTH