Individual
LETICIA JO BURRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 E SHORT AVE, SPOKANE, WA 99202-1555
(509) 838-4651
Mailing address
107 S DIVISION ST, SPOKANE, WA 99202-1510
(509) 838-4651
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG61031957
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/07/2020
Last updated
02/03/2020
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