Provider Demographics
NPI:1225449606
Name:OBERST, JENNIFER LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:OBERST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8826 E ARGONNE LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99212-1795
Mailing Address - Country:US
Mailing Address - Phone:509-981-6065
Mailing Address - Fax:
Practice Address - Street 1:7905 N MEADOWLARK WAY STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-772-3116
Practice Address - Fax:208-772-7677
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30658104100000X
WASA60461160104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASA60461160OtherSOCIAL WORKER ASSOCIATE ADVANCED
IDLMSW-30658OtherLICENSED MASTER SOCIAL WORKER