MEDICARE: THERESA ADAMS 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	L2423	OR
2	1041C0700X	Clinical Social Worker	LW00007389	WA

General Provider Information

NPI Number	:	1841219235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ADAMS LICSW

Provider Business Mailing Address
First Line	:	1960 N HOLY NAMES CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5803
Country	:	US
Telephone Number	:	509-242-2308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 N HOLY NAMES CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5803
Country	:	US
Telephone Number	:	503-242-2308
Fax Number	:

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	10/10/2019

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