Healthcare Provider Details

I. General information

NPI: 1831024926
Provider Name (Legal Business Name): MEDINA CLINICAL EVALUATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201 N SCRIBNER BRANCH RD
SPOKANE WA
99217-9526
US

IV. Provider business mailing address

15201 N SCRIBNER BRANCH RD
SPOKANE WA
99217-9526
US

V. Phone/Fax

Practice location:
  • Phone: 509-251-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBER MEADOW MEDINA
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 509-251-0212