1073851382 NPI number — RIDGWAY & FORSYTH PSYCHOLOGY, P.S.

Table of content: MS. ROSIE THORNTON HARRIS ALC (NPI 1609353036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073851382 NPI number — RIDGWAY & FORSYTH PSYCHOLOGY, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIDGWAY & FORSYTH PSYCHOLOGY, P.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073851382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
628 S MAPLE ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99204-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-353-9885
Provider Business Mailing Address Fax Number:
509-353-9886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
628 S MAPLE ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-353-9885
Provider Business Practice Location Address Fax Number:
509-353-9886
Provider Enumeration Date:
01/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
RIDGWAY
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
509-353-9885

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY1912 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PY2480 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8919067 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8918942 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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