Provider Demographics
NPI:1326570532
Name:PENNINGTON, JANETTE LYNN (CSWA)
Entity Type:Individual
Prefix:MS
First Name:JANETTE
Middle Name:LYNN
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2413
Mailing Address - Country:US
Mailing Address - Phone:208-739-3230
Mailing Address - Fax:
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4566
Practice Address - Country:US
Practice Address - Phone:541-889-2668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA46931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical