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NPI Code Detail

MEDICARE: ELISABETH D BENNETT PHD

MEDICARE: ELISABETH D BENNETT 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
1103TC0700XClinical PsychologistPY00002225WA

General Provider Information

NPI Number : 1467464081
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISABETH D BENNETT PHD
Provider Business Mailing Address
First Line : PO BOX 280
Second Line :
City : COLBERT
State : WA
Zip : 99005-0280
Country : US
Telephone Number : 509-323-3512
Fax Number : 509-323-5964
Provider Business Practice Location Address
First Line : 502 E BOONE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99258-1774
Country : US
Telephone Number : 509-981-8509
Fax Number : 509-323-5964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 07/08/2007

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