Provider Demographics
NPI:1245548981
Name:GREENE, TEDDI L (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:TEDDI
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7615
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1132
Mailing Address - Country:US
Mailing Address - Phone:509-994-6232
Mailing Address - Fax:509-484-2128
Practice Address - Street 1:1124 W RIVERSIDE AVE
Practice Address - Street 2:SUITE LL2
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1132
Practice Address - Country:US
Practice Address - Phone:509-994-6232
Practice Address - Fax:509-484-2128
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 602915691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical