Healthcare Provider Details

I. General information

NPI: 1598787632
Provider Name (Legal Business Name): LADONNA D REMY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23403 E MISSION AVE STE 220F
LIBERTY LAKE WA
99019-5112
US

IV. Provider business mailing address

23403 E MISSION AVE STE 220F
LIBERTY LAKE WA
99019-5112
US

V. Phone/Fax

Practice location:
  • Phone: 509-475-1315
  • Fax:
Mailing address:
  • Phone: 509-475-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00007073
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: