Provider Demographics
NPI:1700666948
Name:MEADOWS AGENCY LLC EDIN AUSBORN DENISON MBR
Entity Type:Organization
Organization Name:MEADOWS AGENCY LLC EDIN AUSBORN DENISON MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENISON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:360-564-0903
Mailing Address - Street 1:316 W BOONE AVE STE 850
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2353
Mailing Address - Country:US
Mailing Address - Phone:360-320-8890
Mailing Address - Fax:
Practice Address - Street 1:316 W BOONE AVE STE 850
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2353
Practice Address - Country:US
Practice Address - Phone:360-564-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty