MEDICARE: DR. SHANN FERCH 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	PY00002058	WA

General Provider Information

NPI Number	:	1700842523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANN FERCH PHD

Provider Business Mailing Address
First Line	:	714 E BOONE
Second Line	:	AD BOX 25
City	:	SPOKANE
State	:	WA
Zip	:	99258-0001
Country	:	US
Telephone Number	:	509-328-4220
Fax Number	:	509-228-9542

Provider Business Practice Location Address
First Line	:	714 E BOONE
Second Line	:	AD BOX 25
City	:	SPOKANE
State	:	WA
Zip	:	99258-0001
Country	:	US
Telephone Number	:	509-328-4220
Fax Number	:	509-228-9542

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/08/2007

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