Provider Demographics
NPI:1649310061
Name:GREEN, DUANE (PHD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W. EIGHTH AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2318
Mailing Address - Country:US
Mailing Address - Phone:509-455-8660
Mailing Address - Fax:509-455-8662
Practice Address - Street 1:105 W. EIGHTH AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2318
Practice Address - Country:US
Practice Address - Phone:509-455-8660
Practice Address - Fax:509-455-8662
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA445103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR79217Medicare UPIN