Healthcare Provider Details

I. General information

NPI: 1265899546
Provider Name (Legal Business Name): LISA M OGRIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA STREET GREEN FLAG BLDG., SUITE 111B
SPOKANE WA
99202
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-599-1093
  • Fax: 509-931-0475
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60580784
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: