Provider Demographics
NPI:1952402083
Name:RIDGWAY, PAMELA S (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 S MAPLE ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3445
Mailing Address - Country:US
Mailing Address - Phone:509-353-9885
Mailing Address - Fax:509-353-9886
Practice Address - Street 1:628 S MAPLE ST
Practice Address - Street 2:STE 102
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3445
Practice Address - Country:US
Practice Address - Phone:509-353-9885
Practice Address - Fax:509-353-9886
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY-2480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB36876Medicare PIN