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General NPI Number Information
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NPI Number | 1427390830
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Entity Type | Individual
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Provider Name | JAN MICHAEL LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2013
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 6304 W RICHARDSON RD
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City | PASCO
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State | WA
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Zip | 99301-1911
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Country | US
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Telephone | 509-851-3280
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Fax | 509-349-5069
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Provider Business Mailing Address
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Address Line | 8350 W GRANDRIDGE BLVD STE 200
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City | KENNEWICK
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State | WA
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Zip | 99336-1678
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Country | US
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Telephone | 509-851-3280
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Fax | 509-349-5069
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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 | LW60549928
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License Number State | WA
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