Healthcare Provider Details

I. General information

NPI: 1891464905
Provider Name (Legal Business Name): INCLUSA HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23403 E MISSION AVE STE 231
LIBERTY LAKE WA
99019-5087
US

IV. Provider business mailing address

21600 E MERIWETHER LN
LIBERTY LAKE WA
99019-7629
US

V. Phone/Fax

Practice location:
  • Phone: 509-367-4209
  • Fax:
Mailing address:
  • Phone: 208-755-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHANIE PERSONDEK
Title or Position: MEMBER
Credential: DO
Phone: 208-755-6731