Healthcare Provider Details

I. General information

NPI: 1639933641
Provider Name (Legal Business Name): LILAC CITY NEUROPSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 S GRAND BLVD STE 203N
SPOKANE WA
99203-2200
US

IV. Provider business mailing address

1403 S GRAND BLVD STE 203N
SPOKANE WA
99203-2200
US

V. Phone/Fax

Practice location:
  • Phone: 509-779-8065
  • Fax: 844-779-0338
Mailing address:
  • Phone: 509-779-8065
  • Fax: 844-779-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: VIRGINIA M. KLEMAN
Title or Position: OWNER
Credential:
Phone: 509-779-8065