Provider Demographics
NPI:1306884713
Name:RAYBUCK, CONNIE S (PHD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:S
Last Name:RAYBUCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S ARTHUR ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2204
Mailing Address - Country:US
Mailing Address - Phone:509-535-6386
Mailing Address - Fax:509-533-0627
Practice Address - Street 1:140 S ARTHUR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2204
Practice Address - Country:US
Practice Address - Phone:509-535-6386
Practice Address - Fax:509-533-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB02336Medicare ID - Type UnspecifiedPSYCHOLOGIST