Provider Demographics
NPI:1306195474
Name:CHRISENBERY, JENNIE D (MS)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:D
Last Name:CHRISENBERY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:D
Other - Last Name:SEDLACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2204 PACIFIC AVE N
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:WA
Mailing Address - Zip Code:98631-3300
Mailing Address - Country:US
Mailing Address - Phone:360-642-3787
Mailing Address - Fax:
Practice Address - Street 1:2204 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:WA
Practice Address - Zip Code:98631-3300
Practice Address - Country:US
Practice Address - Phone:360-642-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500663688Medicaid