Healthcare Provider Details

I. General information

NPI: 1740418276
Provider Name (Legal Business Name): DOUGLAS R. FENDER LICSW, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W 2ND AVE
SPOKANE WA
99201-4412
US

IV. Provider business mailing address

705 W 2ND AVE
SPOKANE WA
99201-4412
US

V. Phone/Fax

Practice location:
  • Phone: 509-462-2500
  • Fax: 509-462-2503
Mailing address:
  • Phone: 509-462-2500
  • Fax: 509-462-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60278349
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00173898
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: