| |
1303 W Maxwell Ave Spokane WA 99201-2714 | |
(509) 747-7147 | |
(509) 323-1607 |
Full Name | |
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Speciality | Social Worker |
Location | 1303 W Maxwell Ave, Spokane, Washington |
Authorized Official Name and Position | Judy Ann Thornton (OWNER/PROVIDER) |
Authorized Official Contact | 5097477147 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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10720 E 15th Ave Spokane Valley WA 99206-5586 Ph: (509) 979-7922 | 1303 W Maxwell Ave Spokane WA 99201-2714 Ph: (509) 747-7147 |
NPI Number | 1902364003 |
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Provider Enumeration Date | 03/07/2019 |
Last Update Date | 12/28/2021 |
Certification Date | 12/28/2021 |
Medicare PECOS PAC ID | 8123356375 |
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Medicare Enrollment ID | O20190826002226 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902364003 | NPI | - | NPPES |
2106599 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
Provider Name | Judy A Thornton |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1093804130 PECOS PAC ID: 7214091297 Enrollment ID: I20090206000079 |
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