Provider Demographics
NPI:1255990701
Name:MANSKE, CORYNN (LICSW)
Entity type:Individual
Prefix:
First Name:CORYNN
Middle Name:
Last Name:MANSKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 N RIVER VISTA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5675
Mailing Address - Country:US
Mailing Address - Phone:208-413-2442
Mailing Address - Fax:
Practice Address - Street 1:1403 S GRAND BLVD STE 101S
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2272
Practice Address - Country:US
Practice Address - Phone:208-413-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-09
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WALW609409081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical