MEDICARE: MR. BRAD ALLAN REIMER 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	LW00008999	WA

General Provider Information

NPI Number	:	1962516559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRAD ALLAN REIMER LICSW

Provider Business Mailing Address
First Line	:	100 N MULLAN RD
Second Line	:	SUITE 202
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6848
Country	:	US
Telephone Number	:	509-926-6581
Fax Number	:	509-921-1375

Provider Business Practice Location Address
First Line	:	100 N MULLAN RD
Second Line	:	SUITE 202
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6848
Country	:	US
Telephone Number	:	509-926-6581
Fax Number	:	509-921-1375

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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