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General NPI Number Information
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NPI Number | 1508264185
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Entity Type | Individual
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Provider Name | JENNIFER A.L. BAYNE LW60694899
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Gender | Female
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 315 MARTIN LUTHER KING JR WAY MS: 315-C4-CHF
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-403-1408
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Fax | 253-403-4591
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Provider Business Mailing Address
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Address Line | 315 MARTIN LUTHER KING JR WAY MS: 315-C4-CHF
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City | TACOMA
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State | WA
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Zip | 98405
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Country | US
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Telephone | 253-403-1408
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Fax | 253-403-4591
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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 | SC60364820
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License Number State | WA
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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 | LW60694899
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License Number State | WA
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