Healthcare Provider Details

I. General information

NPI: 1043230758
Provider Name (Legal Business Name): SAMANTHA SUSAN-MARIE CHANDLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W RIVERSIDE AVE SUITE 208
SPOKANE WA
99201-1016
US

IV. Provider business mailing address

2002 E BRIDGEPORT AVE
SPOKANE WA
99207-4608
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-0165
  • Fax:
Mailing address:
  • Phone: 509-880-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY00002704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: