MEDICARE: ANGELA RUTH DIERDORFF LMHCA

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	101YM0800X	Mental Health Counselor	NHCA.MC70115468	WA

General Provider Information

NPI Number	:	1487458121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA RUTH DIERDORFF LMHCA

Provider Business Mailing Address
First Line	:	101 W CASCADE WAY STE 103
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6000
Country	:	US
Telephone Number	:	509-413-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W CASCADE WAY STE 103
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6000
Country	:	US
Telephone Number	:	509-413-2242
Fax Number	:

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

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	05/11/2026

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