Basic Information
Provider Information
NPI: 1053477661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIZZARDI
FirstName: SHEREE
MiddleName: M
NamePrefix: MS.
NameSuffix:  
Credential: MED
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1511 W MANSFIELD AVE
Address2:  
City: SPOKANE
State: WA
PostalCode: 992054332
CountryCode: US
TelephoneNumber: 5093281995
FaxNumber: 5093632762
Practice Location
Address1: 107 S DIVISION ST
Address2:  
City: SPOKANE
State: WA
PostalCode: 992021510
CountryCode: US
TelephoneNumber: 5098384651
FaxNumber: 5093632762
Other Information
ProviderEnumerationDate: 12/28/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XLH00009317WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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