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525 W 2nd Ave Spokane WA 99201-4301 | |
| (509) 624-2378 | |
| (509) 624-2275 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 525 W 2nd Ave, Spokane, Washington |
| Authorized Official Name and Position | Fawn Schott (CHIEF EXECUTIVE OFFICER/PRESIDENT) |
| Authorized Official Contact | 5096242378 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
525 W 2nd Ave Spokane WA 99201-4301 Ph: (509) 624-2378 | 525 W 2nd Ave Spokane WA 99201-4301 Ph: (509) 624-2378 |
| NPI Number | 1518153998 |
|---|---|
| Provider Enumeration Date | 09/19/2007 |
| Last Update Date | 12/30/2022 |
| Certification Date | 12/30/2022 |
| Medicare PECOS PAC ID | 2264803246 |
|---|---|
| Medicare Enrollment ID | O20230131000529 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518153998 | NPI | - | NPPES |
| Provider Name | Breanna Louise Carter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902344955 PECOS PAC ID: 8921470774 Enrollment ID: I20230206000051 |
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