Provider Demographics
NPI:1518951094
Name:SPOKANE PSYCHOLOGY AND NEUROPSYCHOLOGY, PS
Entity type:Organization
Organization Name:SPOKANE PSYCHOLOGY AND NEUROPSYCHOLOGY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNE
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:509-838-7400
Mailing Address - Street 1:105 W 8TH AVE
Mailing Address - Street 2:SUITE 332C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2302
Mailing Address - Country:US
Mailing Address - Phone:509-838-7400
Mailing Address - Fax:509-838-6827
Practice Address - Street 1:105 W 8TH AVE
Practice Address - Street 2:SUITE 332C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-838-7400
Practice Address - Fax:509-838-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8856108Medicare ID - Type UnspecifiedNORIDIAN MEDICARE - GROUP