Provider Demographics
NPI:1154397115
Name:KOFFMAN, STEVEN D (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:KOFFMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 W OWENS RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9700
Mailing Address - Country:US
Mailing Address - Phone:509-323-6290
Mailing Address - Fax:509-323-5964
Practice Address - Street 1:714 E BOONE
Practice Address - Street 2:ROSAUER JCENTER EDUCATION RC 268
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99258-0001
Practice Address - Country:US
Practice Address - Phone:509-323-6290
Practice Address - Fax:509-323-5964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002835103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical