Healthcare Provider Details

I. General information

NPI: 1801899109
Provider Name (Legal Business Name): DEBBIE BARDWELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N ARGONNE RD STE 207
SPOKANE VALLEY WA
99212-2721
US

IV. Provider business mailing address

PO BOX 13074
SPOKANE VALLEY WA
99213-3074
US

V. Phone/Fax

Practice location:
  • Phone: 509-263-3060
  • Fax: 509-448-0958
Mailing address:
  • Phone: 509-263-3060
  • Fax: 509-448-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY1721
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF 1117
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: