Organization
NATIVE PROJECT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONI LODGE (EXECUTIVE DIRECTOR)
(509) 325-5502
Entity
Organization
Contact information
Practice address
1803 W MAXWELL AVE, SPOKANE, WA 99201
(509) 325-5502
(509) 482-2794
Mailing address
1803 W MAXWELL AVE, SPOKANE, WA 99201
(509) 325-5502
(509) 482-2794
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
133V00000X
Registered Dietitian
—
WA
163W00000X
Registered Nurse
—
WA
163WD0400X
Diabetes Educator Registered Nurse
RN00122081
WA
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
601182805
WA
291U00000X
Clinical Medical Laboratory
50D0968048
WA
363LF0000X
Family Nurse Practitioner
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003480
—
WA
05
—
1007817
—
WA
05
—
7098320
—
WA
05
—
7591100
—
WA
Enumeration date
10/26/2006
Last updated
12/17/2024
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