Healthcare Provider Details

I. General information

NPI: 1386118438
Provider Name (Legal Business Name): JENNIFER LEE PAINTER LICSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 W GARLAND AVE
SPOKANE WA
99205-2526
US

IV. Provider business mailing address

2118 W GARLAND AVE
SPOKANE WA
99205-2526
US

V. Phone/Fax

Practice location:
  • Phone: 610-329-1875
  • Fax: 509-354-5930
Mailing address:
  • Phone: 610-329-1875
  • Fax: 509-354-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: