MEDICARE: DR. STEVEN D KOFFMAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY00002835	WA

General Provider Information

NPI Number	:	1154397115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN D KOFFMAN PHD

Provider Business Mailing Address
First Line	:	3514 W OWENS RD
Second Line	:
City	:	DEER PARK
State	:	WA
Zip	:	99006-9700
Country	:	US
Telephone Number	:	509-323-6290
Fax Number	:	509-323-5964

Provider Business Practice Location Address
First Line	:	714 E BOONE
Second Line	:	ROSAUER JCENTER EDUCATION RC 268
City	:	SPOKANE
State	:	WA
Zip	:	99258-0001
Country	:	US
Telephone Number	:	509-323-6290
Fax Number	:	509-323-5964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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