Healthcare Provider Details

I. General information

NPI: 1619970241
Provider Name (Legal Business Name): DAVID L BRUXER M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

IV. Provider business mailing address

2003 S LIBERTY DR
LIBERTY LAKE WA
99019-9782
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-5072
  • Fax: 509-747-0609
Mailing address:
  • Phone: 509-255-6330
  • Fax: 509-747-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00004324
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLW00004324
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLH00004581
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLF00001420
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: