1295828721 NPI number — MRS. JENNIFER IRENE POTTERTON MSW LSW BC

Table of content: MRS. JENNIFER IRENE POTTERTON MSW LSW BC (NPI 1295828721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295828721 NPI number — MRS. JENNIFER IRENE POTTERTON MSW LSW BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POTTERTON
Provider First Name:
JENNIFER
Provider Middle Name:
IRENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LSW BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIERCE
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
IRENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295828721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 TIETON DRIVE SUITE C
Provider Second Line Business Mailing Address:
CATHOLIC FAMILY & CHILD SERVICE
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-3478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-965-7100
Provider Business Mailing Address Fax Number:
509-966-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 TIETON DRIVE SUITE C
Provider Second Line Business Practice Location Address:
CATHOLIC FAMILY & CHILD SERVICE
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-7100
Provider Business Practice Location Address Fax Number:
509-966-3478
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  RC00038391 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)