Provider Demographics
NPI:1235962556
Name:PULLEN-VILLAREAL, IRIS ROSE (MSW, BSW)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:ROSE
Last Name:PULLEN-VILLAREAL
Suffix:
Gender:F
Credentials:MSW, BSW
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:ROSE
Other - Last Name:PULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0206
Mailing Address - Country:US
Mailing Address - Phone:509-354-7946
Mailing Address - Fax:509-835-1281
Practice Address - Street 1:200 N BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0206
Practice Address - Country:US
Practice Address - Phone:509-354-7946
Practice Address - Fax:509-835-1281
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61577616104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker