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General NPI Number Information
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NPI Number | 1326919739
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Entity Type | Organization
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Legal Business Name | RESTORING ROOTS THERAPY PLLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 12/06/2025
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Provider Practice Location Address
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Address Line | 104 S FREYA ST. SUITE 225B TURQUOISE FLAG BUILDING,
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City | SPOKANE
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State | WA
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Zip | 99202
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Country | US
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Telephone | 509-289-4245
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Fax |
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Provider Business Mailing Address
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Address Line | TAPIO CENTER, TURQUIOISE FLAG BUILDING, SUITE 225-B 104 S FREYA ST.
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City | SPOKANE
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State | WA
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Zip | 99202
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Country | US
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Telephone | 509-289-4245
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | TAYLOR KENNEDY
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Credential | LCSW
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Telephone | 509-929-0511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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