Provider Demographics
NPI:1861259574
Name:REDEKER, TAMARA LEIGH (SUDPT, CAAR)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEIGH
Last Name:REDEKER
Suffix:
Gender:F
Credentials:SUDPT, CAAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15407 E MISSION AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8527
Mailing Address - Country:US
Mailing Address - Phone:509-844-7967
Mailing Address - Fax:
Practice Address - Street 1:15407 E MISSION AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8527
Practice Address - Country:US
Practice Address - Phone:509-844-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61533177101YA0400X
WACG61533173390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)