MEDICARE: LEE W WEGENKE SALKIN LMHC, CDP

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	101Y00000X	Counselor	60289923	WA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	60289917	WA

General Provider Information

NPI Number	:	1215082714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE W WEGENKE SALKIN LMHC, CDP

Provider Business Mailing Address
First Line	:	PO BOX 965
Second Line	:
City	:	MEAD
State	:	WA
Zip	:	99021-0965
Country	:	US
Telephone Number	:	509-299-0945
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 N ARGONNE RD
Second Line	:	BLDG. B, SUITE 105
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2868
Country	:	US
Telephone Number	:	509-299-0945
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	05/10/2017

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