Provider Demographics
NPI:1134171325
Name:STEVENS, CLINT (RDMS, RVT, RT(R))
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:RDMS, RVT, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8162
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-0162
Mailing Address - Country:US
Mailing Address - Phone:509-747-7427
Mailing Address - Fax:888-343-6937
Practice Address - Street 1:3026 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2560
Practice Address - Country:US
Practice Address - Phone:509-747-7427
Practice Address - Fax:888-343-6937
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA408822471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography