Healthcare Provider Details

I. General information

NPI: 1689798316
Provider Name (Legal Business Name): MS. JENNY LYNN CIOLLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E SPRAGUE AVE
SPOKANE WA
99202-1534
US

IV. Provider business mailing address

210 E SPRAGUE AVE
SPOKANE WA
99202-1534
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-5004
  • Fax:
Mailing address:
  • Phone: 509-343-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00054178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: