MEDICARE: MS. TEDDI L GREENE MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW 60291569	WA

General Provider Information

NPI Number	:	1245548981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TEDDI L GREENE MSW, LICSW

Provider Business Mailing Address
First Line	:	PO BOX 7615
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-1132
Country	:	US
Telephone Number	:	509-994-6232
Fax Number	:	509-484-2128

Provider Business Practice Location Address
First Line	:	1124 W RIVERSIDE AVE
Second Line	:	SUITE LL2
City	:	SPOKANE
State	:	WA
Zip	:	99201-1132
Country	:	US
Telephone Number	:	509-994-6232
Fax Number	:	509-484-2128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	04/08/2017

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