Healthcare Provider Details

I. General information

NPI: 1487120168
Provider Name (Legal Business Name): ANNA MIKAEL VULETICH BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

IV. Provider business mailing address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

V. Phone/Fax

Practice location:
  • Phone: 509-477-4391
  • Fax: 509-477-3615
Mailing address:
  • Phone: 509-477-4391
  • Fax: 509-477-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCG60805362
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: