Healthcare Provider Details

I. General information

NPI: 1154397115
Provider Name (Legal Business Name): STEVEN D KOFFMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E BOONE ROSAUER JCENTER EDUCATION RC 268
SPOKANE WA
99258-0001
US

IV. Provider business mailing address

3514 W OWENS RD
DEER PARK WA
99006-9700
US

V. Phone/Fax

Practice location:
  • Phone: 509-323-6290
  • Fax: 509-323-5964
Mailing address:
  • Phone: 509-323-6290
  • Fax: 509-323-5964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00002835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: