Provider Demographics
NPI:1295922672
Name:NEILS, ROB (PHD)
Entity type:Individual
Prefix:DR
First Name:ROB
Middle Name:
Last Name:NEILS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:G
Other - Last Name:NEILS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1005 PINES RD N
Mailing Address - Street 2:STE 250
Mailing Address - City:SPOKANE VLY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4993
Mailing Address - Country:US
Mailing Address - Phone:509-927-1194
Mailing Address - Fax:509-927-8819
Practice Address - Street 1:1005 PINES RD N
Practice Address - Street 2:STE 250
Practice Address - City:SPOKANE VLY
Practice Address - State:WA
Practice Address - Zip Code:99206-4993
Practice Address - Country:US
Practice Address - Phone:509-927-1194
Practice Address - Fax:509-927-8819
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA943103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB08695Medicare PIN