MEDICARE: DR. DEBBIE BARDWELL PH.D.

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	106H00000X	Marriage & Family Therapist	LF 1117	WA
2	103T00000X	Psychologist	PY1721	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BA8938	OTHER	WA	REGENCE BLUESHIELD

General Provider Information

NPI Number	:	1801899109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBBIE BARDWELL PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 13074
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99213-3074
Country	:	US
Telephone Number	:	509-263-3060
Fax Number	:	509-448-0958

Provider Business Practice Location Address
First Line	:	920 N ARGONNE RD STE 207
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-2721
Country	:	US
Telephone Number	:	509-263-3060
Fax Number	:	509-448-0958

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/17/2022

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