Individual
J- OLD SHOES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S DIVISION ST, SPOKANE, WA 99202-1510
(509) 838-4651
Mailing address
107 S DIVISION ST, SPOKANE, WA 99202-1510
(509) 838-4651
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
61611593
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
WA
Other
Enumeration date
10/14/2024
Last updated
10/14/2024
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