MEDICARE: ANNTONETTE R CALDWELL

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CO70013650	WA
2	103K00000X	Behavior Analyst		WA

General Provider Information

NPI Number	:	1396383642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNTONETTE R CALDWELL

Provider Business Mailing Address
First Line	:	1710 E SANSON AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-4071
Country	:	US
Telephone Number	:	253-592-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 E SANSON AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-4071
Country	:	US
Telephone Number	:	253-592-8423
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	02/12/2026

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Directions to “ ANNTONETTE R CALDWELL ” Practice Location

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