MEDICARE: MRS. CINDI L FULLER MSW

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	LH00009190	WA

General Provider Information

NPI Number	:	1356400436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CINDI L FULLER MSW

Provider Business Mailing Address
First Line	:	1623 W GARDNER AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1830
Country	:	US
Telephone Number	:	509-328-6274
Fax Number	:	509-326-2341

Provider Business Practice Location Address
First Line	:	1623 W GARDNER AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1830
Country	:	US
Telephone Number	:	509-328-6274
Fax Number	:	509-326-2341

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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