Healthcare Provider Details

I. General information

NPI: 1023922861
Provider Name (Legal Business Name): PEMBER CLAIRE VANDIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S JEFFERSON ST STE 304
SPOKANE WA
99204-3144
US

IV. Provider business mailing address

1414 W 13TH AVE
SPOKANE WA
99204-4016
US

V. Phone/Fax

Practice location:
  • Phone: 509-903-5631
  • Fax:
Mailing address:
  • Phone: 760-996-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.70134169
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: