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General NPI Number Information
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NPI Number | 1316113533
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Entity Type | Individual
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Provider Name | JENNIPHER LYNNE MANGANARO MSW
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Gender | Female
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 325 9TH AVE MAIL STOP 359760
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City | SEATTLE
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State | WA
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Zip | 98104-2499
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Country | US
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Telephone | 206-744-4363
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Fax | 206-744-8274
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Provider Business Mailing Address
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Address Line | 325 9TH AVE MAIL STOP 359760
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City | SEATTLE
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State | WA
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Zip | 98104-2499
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Country | US
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Telephone | 206-744-4363
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Fax | 206-744-8274
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | RC00058956
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License Number State | WA
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