Healthcare Provider Details

I. General information

NPI: 1881164978
Provider Name (Legal Business Name): SERGIY BEREZHNOY CO 60911229
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E ROWAN AVE
SPOKANE WA
99207-1240
US

IV. Provider business mailing address

14819 E MISSION AVE
SPOKANE VALLEY WA
99216-1960
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-6446
  • Fax: 509-252-6490
Mailing address:
  • Phone: 509-315-9812
  • Fax: 509-474-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC61200656
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: