Individual
ANNETTA ELIZABETH THEADEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CO60546132
Contact information
Practice address
312 W 8TH AVE, SPOKANE, WA 99204-2506
(509) 477-4652
Mailing address
312 W 8TH AVE, SPOKANE, WA 99204-2506
(509) 477-4652
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CO60546132
WA
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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