Healthcare Provider Details

I. General information

NPI: 1922748151
Provider Name (Legal Business Name): LEGACY LEARNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S GARFIELD ST APT 16
SPOKANE WA
99202-5089
US

IV. Provider business mailing address

PO BOX 2561
SPOKANE WA
99220-2561
US

V. Phone/Fax

Practice location:
  • Phone: 509-842-6958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATESHA WOOD
Title or Position: DIRECTOR
Credential: BCBA
Phone: 509-842-6958