Healthcare Provider Details

I. General information

NPI: 1154892719
Provider Name (Legal Business Name): SHAWNI EILEEN STORMS CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

IV. Provider business mailing address

12715 E MISSION AVE
SPOKANE VALLEY WA
99216-1027
US

V. Phone/Fax

Practice location:
  • Phone: 509-232-5766
  • Fax: 509-232-5770
Mailing address:
  • Phone: 509-232-5766
  • Fax: 509-232-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00006425
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: