Healthcare Provider Details

I. General information

NPI: 1568927168
Provider Name (Legal Business Name): SCOTT GILBERT LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14402 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2167
US

IV. Provider business mailing address

14402 E SPRAGUE AVE
SPOKANE VALLEY WA
99216-2167
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-2625
  • Fax:
Mailing address:
  • Phone: 509-922-2625
  • Fax: 509-922-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60831368
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: