MEDICARE: TERESA TAFT M.S.W. 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	LW00004278	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	7655221	OTHER	AETNA
2	2687TA	OTHER	ASURIS NW HEALTH
3	000010148106	OTHER	BLUE SHIELD OF IDAHO

General Provider Information

NPI Number	:	1548250533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA TAFT M.S.W. LICSW

Provider Business Mailing Address
First Line	:	PO BOX 3868
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-3868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12615 E MISSION AVE
Second Line	:	SUITE 200
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1047
Country	:	US
Telephone Number	:	509-228-1200
Fax Number	:	509-252-9300

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	12/31/2007

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Directions to “ TERESA TAFT M.S.W. LICSW” Practice Location

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