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General NPI Number Information
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NPI Number | 1356968895
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Entity Type | Organization
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Legal Business Name | JENNDA LLC
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 4305 N ROYAL ST
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City | COEUR D ALENE
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State | ID
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Zip | 83815-9237
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Country | US
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Telephone | 208-889-8594
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19604
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City | SPOKANE
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State | WA
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Zip | 99219-0034
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Country | US
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Telephone | 208-889-8594
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JENNIFER ANN HAWKINS
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Credential | MS, SUDP
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Telephone | 208-889-8594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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