MEDICARE: CONNIE G SILK RC

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	101YM0800X	Mental Health Counselor	RC00008986	WA

General Provider Information

NPI Number	:	1750567988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE G SILK RC

Provider Business Mailing Address
First Line	:	PO BOX 2808
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-2800
Country	:	US
Telephone Number	:	509-688-6702
Fax Number	:	509-688-6792

Provider Business Practice Location Address
First Line	:	9631 N NEVADA ST
Second Line	:	SUITE 100
City	:	SPOKANE
State	:	WA
Zip	:	99218-1133
Country	:	US
Telephone Number	:	509-688-6760
Fax Number	:	509-688-6769

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

Provider Enumeration Date	:	01/17/2008
Last Update Date	:	01/17/2008

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Directions to “ CONNIE G SILK RC” Practice Location

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