Provider Demographics
NPI:1952882078
Name:SMITH, MARILYN LOUISE (RPSGT)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LOUISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:LOUISE
Other - Last Name:STETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPSGT
Mailing Address - Street 1:12615 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-232-3959
Mailing Address - Fax:509-343-0154
Practice Address - Street 1:12615 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-232-3959
Practice Address - Fax:509-343-0154
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12062174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator