| Colonial Clinic Iii, Llc | |
|
910 N Washington St Ste 210 Spokane WA 99201-2260 | |
| (509) 327-9831 | |
| (509) 327-9857 |
| Full Name | Colonial Clinic Iii, Llc |
|---|---|
| Speciality | Early Intervention Provider Agency |
| Location | 910 N Washington St Ste 210, Spokane, Washington |
| Authorized Official Name and Position | Thomas H. Stolz Huston Stolz (CLINIC DIRECTOR/COUNSELOR) |
| Authorized Official Contact | 5093279831 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colonial Clinic Iii, Llc 910 N Washington St Ste 210 Spokane WA 99201-2260 Ph: (509) 327-9831 | Colonial Clinic Iii, Llc 910 N Washington St Ste 210 Spokane WA 99201-2260 Ph: (509) 327-9831 |
| NPI Number | 1447590757 |
|---|---|
| Provider Enumeration Date | 02/22/2013 |
| Last Update Date | 02/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447590757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 32025500 (Washington) | Secondary |
| 252Y00000X | Early Intervention Provider Agency | 32025500 (Washington) | Primary |
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