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General NPI Number Information
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NPI Number | 1730041492
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Entity Type | Individual
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Provider Name | MADELEINE WADE KRUTZ
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 421 W RIVERSIDE AVE STE 1600
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City | SPOKANE
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State | WA
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Zip | 99201-0406
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Country | US
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Telephone | 509-481-9629
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Fax | 509-381-3538
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Provider Business Mailing Address
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Address Line | 421 W RIVERSIDE AVE STE 1600
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City | SPOKANE
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State | WA
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Zip | 99201-0406
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Country | US
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Telephone | 509-481-9629
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Fax | 509-413-6875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61559049
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License Number State | WA
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