Annetta Elizabeth Theademan, CO60546132

Primary specialty

CounselorTaxonomy code 101Y00000X

License

CO60546132 Issued in WA

Practice address

312 W 8TH Ave
Spokane, WA 99204-2506

Phone

(509) 477-4652

NPI assigned

Oct 3, 2018

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Detox Services of Spokane

  • Adult Mental Health Clinic/Center
  • Spokane, WA
  • NPI 1841957990
  NPD
• Spokane Treatment and Recovery Services

  • Addiction (Substance Use Disorder) Counselor
  • Spokane, WA
  • NPI 1104957323
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/spokanerecovery/r4/

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 3, 2018.

{
    "created_epoch": "1538524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1578038709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042506",
            "telephone_number": "509-477-4652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 W 8TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042506",
            "telephone_number": "509-477-4652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEADEMAN",
        "first_name": "ANNETTA",
        "middle_name": "ELIZABETH",
        "credential": "CO60546132",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-03",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CO60546132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Next Step a Woman'S Boutique LLC
• The Queens Adult Family Home LLC
• The Salvation Army Spokane Corp
• The Shades of Motherhood Network
• The Wisdom Well LLC
• Catherine Theobald
• Peter J Theobald
• Angelica Rose Theophile, BEHAVIORAL SUPPORT
• Therapeutic Associates Inc
• Therapeutic Associates Inc

• All providers in Spokane, WA
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.