Provider Demographics
NPI:1295489763
Name:BABCOCK, DOROTHY (EP-C)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:F
Credentials:EP-C
Other - Prefix:
Other - First Name:DORI
Other - Middle Name:
Other - Last Name:BABCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EP-C
Mailing Address - Street 1:8900 S MULLEN HILL RD TRLR 817
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9273
Mailing Address - Country:US
Mailing Address - Phone:509-270-8697
Mailing Address - Fax:
Practice Address - Street 1:8900 S MULLEN HILL RD TRLR 817
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9273
Practice Address - Country:US
Practice Address - Phone:509-270-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialist
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3147OtherVHS LLC
3147OtherVALIANT HEALTH SOLUTIONS LLC