Provider Demographics
NPI:1649712498
Name:PAANANEN, CAROLYN AMANDA
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:AMANDA
Last Name:PAANANEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 N DIVISION ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1969
Mailing Address - Country:US
Mailing Address - Phone:509-319-2231
Mailing Address - Fax:509-319-2236
Practice Address - Street 1:11909 N DIVISION ST STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1969
Practice Address - Country:US
Practice Address - Phone:509-319-2231
Practice Address - Fax:509-319-2236
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-39172103K00000X
WA61597899103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst