Organization
SPOKANE PSYCHIATRIC CLINIC PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERENE G ROCKSTROM (OFFICE MANAGER)
(509) 455-9090
Entity
Organization
Contact information
Practice address
105 W 8TH AVE, 6055, SPOKANE, WA 99204
(509) 455-9090
(509) 747-2118
Mailing address
105 W 8TH AVE, 6055, SPOKANE, WA 99204
(509) 455-9090
(509) 747-2118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00015837
WA
2084P0800X
Psychiatry Physician
MD00017775
WA
2084P0800X
Psychiatry Physician
MD00018006
WA
2084P0800X
Psychiatry Physician
MD00019775
WA
2084P0800X
Psychiatry Physician
MD00021497
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0034874
L & I
—
05
—
1077775
—
WA
05
—
1077783
—
WA
05
—
1077791
—
WA
05
—
1077817
—
WA
05
—
1080191
—
WA
Enumeration date
12/21/2006
Last updated
08/22/2020
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