Healthcare Provider Details

I. General information

NPI: 1699691907
Provider Name (Legal Business Name): JOLENA PATRICIA YOUNG MSW, AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S FREYA ST STE 212
SPOKANE WA
99202-4871
US

IV. Provider business mailing address

25524 E EDDY LN
NEWMAN LAKE WA
99025-9435
US

V. Phone/Fax

Practice location:
  • Phone: 509-368-9863
  • Fax: 509-587-1575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70064481
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: