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General NPI Number Information
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NPI Number | 1316304678
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Entity Type | Individual
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Provider Name | JEANNIE DALTON LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 23505 E APPLEWAY AVE STE 200 #200-1026
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-6003
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Country | US
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Telephone | 509-253-7834
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 N CABINET ST
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City | POST FALLS
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State | ID
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Zip | 83854-6037
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Country | US
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Telephone | 208-859-6840
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-37907
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61470969
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License Number State | WA
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