MEDICARE: BRIANNE RENAE BAUGHN 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	LW61121975	WA

General Provider Information

NPI Number	:	1669116984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNE RENAE BAUGHN LICSW

Provider Business Mailing Address
First Line	:	60835 LAKE SPOKANE DR
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-5137
Country	:	US
Telephone Number	:	509-638-9531
Fax Number	:

Provider Business Practice Location Address
First Line	:	60835 LAKE SPOKANE DR
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-5137
Country	:	US
Telephone Number	:	509-638-9531
Fax Number	:

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

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/22/2022

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