Provider Demographics
NPI:1063791374
Name:OSWALD, SAMANTHA A (CDP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:OSWALD
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 W MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2831
Mailing Address - Country:US
Mailing Address - Phone:509-325-5502
Mailing Address - Fax:509-325-9839
Practice Address - Street 1:1803 W MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2831
Practice Address - Country:US
Practice Address - Phone:509-325-5502
Practice Address - Fax:509-325-9839
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60209043101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063791374Medicaid