Provider Demographics
NPI:1124170279
Name:COGDILL, DIAN LYNN (LMP)
Entity type:Individual
Prefix:MRS
First Name:DIAN
Middle Name:LYNN
Last Name:COGDILL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12922 E 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-8405
Mailing Address - Country:US
Mailing Address - Phone:509-294-1726
Mailing Address - Fax:
Practice Address - Street 1:12205 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5461
Practice Address - Country:US
Practice Address - Phone:509-294-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist