Healthcare Provider Details

I. General information

NPI: 1427115765
Provider Name (Legal Business Name): NORTHWEST NEUROBEHAVIORAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 N DIVISION ST SUITE A
SPOKANE WA
99202-1930
US

IV. Provider business mailing address

1303 N DIVISION ST SUITE A
SPOKANE WA
99202-1930
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-3600
  • Fax: 509-747-4420
Mailing address:
  • Phone: 509-456-3600
  • Fax: 509-747-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY00003323
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY00002557
License Number StateWA

VIII. Authorized Official

Name: DR. CHRISTINE RICHELLE GUZZARDO
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 509-456-3600