Healthcare Provider Details

I. General information

NPI: 1598511305
Provider Name (Legal Business Name): KASSANDRA MARJORIE MATVEEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA MARJORIE MALMSTROM

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W 7TH AVE STE 200
SPOKANE WA
99204-2833
US

IV. Provider business mailing address

823 E NORTH AVE
SPOKANE WA
99207-3413
US

V. Phone/Fax

Practice location:
  • Phone: 509-850-1080
  • Fax:
Mailing address:
  • Phone: 509-904-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70123612
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: