Healthcare Provider Details

I. General information

NPI: 1487458121
Provider Name (Legal Business Name): ANGELA RUTH DIERDORFF LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W CASCADE WAY STE 103
SPOKANE WA
99208-6000
US

IV. Provider business mailing address

101 W CASCADE WAY STE 103
SPOKANE WA
99208-6000
US

V. Phone/Fax

Practice location:
  • Phone: 509-413-2242
  • Fax:
Mailing address:
  • Phone: 509-413-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNHCA.MC70115468
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: