Provider Demographics
NPI:1992034938
Name:MCNIVEN, RAYMON D (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:RAYMON
Middle Name:D
Last Name:MCNIVEN
Suffix:
Gender:M
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N DIVISION ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2110
Mailing Address - Country:US
Mailing Address - Phone:509-993-6348
Mailing Address - Fax:
Practice Address - Street 1:2309 N DIVISION ST STE 1
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-2110
Practice Address - Country:US
Practice Address - Phone:509-993-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60120785231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259611OtherL&I
WA2005965Medicaid
WA2005965Medicaid