Healthcare Provider Details

I. General information

NPI: 1649744061
Provider Name (Legal Business Name): PAUL ANDREW RUGGIERO-SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 7TH ST
CLARKSTON WA
99403-2005
US

IV. Provider business mailing address

900 7TH ST
CLARKSTON WA
99403-2005
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-3341
  • Fax:
Mailing address:
  • Phone: 509-758-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: