Healthcare Provider Details

I. General information

NPI: 1982440491
Provider Name (Legal Business Name): MARS DEARMAN LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date: 07/05/2025
Reactivation Date: 08/11/2025

III. Provider practice location address

1325 W 1ST AVE STE 226
SPOKANE WA
99201-4600
US

IV. Provider business mailing address

1325 W 1ST AVE STE 226
SPOKANE WA
99201-4600
US

V. Phone/Fax

Practice location:
  • Phone: 509-818-0176
  • Fax:
Mailing address:
  • Phone: 206-482-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC61673076
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: