MEDICARE: JEFFREY MICHAEL WIRTH

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1508163361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY MICHAEL WIRTH

Provider Business Mailing Address
First Line	:	325 S UNIVERSITY RD
Second Line	:	SUITE 202
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6164
Country	:	US
Telephone Number	:	509-434-9128
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 S UNIVERSITY RD
Second Line	:	SUITE 202
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6164
Country	:	US
Telephone Number	:	509-434-9128
Fax Number	:

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	04/12/2017

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