Organization
CENTENNIAL PEDIATRICS OF SPOKANE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER KALISVAART MD (OWNER)
(562) 277-0834
Entity
Organization
Contact information
Practice address
3010 S SOUTHEAST BLVD STE A, SPOKANE, WA 99223-3540
(509) 352-3777
(509) 343-3717
Mailing address
3010 S SOUTHEAST BLVD STE A, SPOKANE, WA 99223-3540
(509) 352-3777
(509) 343-3717
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
208000000X
Pediatrics Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
09/28/2022
Last updated
07/21/2023
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