Healthcare Provider Details

I. General information

NPI: 1225853096
Provider Name (Legal Business Name): ANDI M PUZANKOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BERNARD ST
SPOKANE WA
99201-0206
US

IV. Provider business mailing address

200 N BERNARD ST
SPOKANE WA
99201-0206
US

V. Phone/Fax

Practice location:
  • Phone: 509-354-7946
  • Fax:
Mailing address:
  • Phone: 509-354-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61613321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: