Healthcare Provider Details

I. General information

NPI: 1073655940
Provider Name (Legal Business Name): ICARD, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W 7TH AVE SUITE 130
SPOKANE WA
99204-2843
US

IV. Provider business mailing address

701 W 7TH AVE SUITE 130
SPOKANE WA
99204-2843
US

V. Phone/Fax

Practice location:
  • Phone: 509-869-3809
  • Fax: 509-838-1163
Mailing address:
  • Phone: 509-869-3809
  • Fax: 509-838-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002566
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00004374
License Number StateWA

VIII. Authorized Official

Name: DR. ELIZABETH A PECHOUS
Title or Position: COFOUNDER/CLINICAL DIRECTOR
Credential: PHD
Phone: 509-869-3809