Provider Demographics
NPI:1306204995
Name:DENENNY, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DENENNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E SPRAGUE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2110
Mailing Address - Country:US
Mailing Address - Phone:509-822-7395
Mailing Address - Fax:
Practice Address - Street 1:715 E SPRAGUE AVE STE 115
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2110
Practice Address - Country:US
Practice Address - Phone:509-822-7395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60600501101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP 60600501OtherWASHINGTON STATE DEPARTMENT OFHEALTH