Healthcare Provider Details

I. General information

NPI: 1194886663
Provider Name (Legal Business Name): MICHELLE M. WHITE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE M. SERWAT

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S UNIVERSITY RD SUITE 202
SPOKANE VALLEY WA
99206-5227
US

IV. Provider business mailing address

325 S UNIVERSITY RD STE 202
SPOKANE VALLEY WA
99206-6164
US

V. Phone/Fax

Practice location:
  • Phone: 509-534-9380
  • Fax: 509-534-9385
Mailing address:
  • Phone: 509-534-9380
  • Fax: 509-534-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY00001933
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00001933
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: