Healthcare Provider Details

I. General information

NPI: 1558596775
Provider Name (Legal Business Name): JEANNE LAREE WHITE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 E. OLD SCHOOL RD.
WELLPINIT WA
99040
US

IV. Provider business mailing address

5232 C ALLEN RD.
SPRINGDALE WA
99173
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-7502
  • Fax: 509-258-4480
Mailing address:
  • Phone: 509-258-9311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00005869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: